RN Utilization Review Manager - Health Plan Leadership

Contra Costa County; Martinez (CA); On-site; USD 85,000 - 105,000; Full time

Benefits offered by this job

Health coverage

Professional development opportunities

Job summary

A local health services provider in Martinez, CA is seeking an experienced Utilization Review Manager to oversee case management operations. You will manage a team, ensure effective care coordination, and navigate complex regulatory environments. Candidates must have a nursing degree, valid license, and significant experience in managed care. The role demands strong leadership, analytical skills, and a commitment to improving care for members in accordance with regulatory standards.

Qualifications

• Must have a current, valid nursing license.
• Three years experience as a Registered Nurse in managed care organizations.
• At least one year of supervisory experience.

Responsibilities

• Manage clinical review operations and authorizations.
• Lead development of utilization management policies.
• Ensure compliance with turnaround times.
• Prepare for and respond to audits.

Skills

Leadership

Regulatory Compliance Knowledge

Analytical Skills

Communication

Team Management

Education

Bachelor's degree in nursing

Job description

A local health services provider in Martinez, CA is seeking an experienced Utilization Review Manager to oversee case management operations. You will manage a team, ensure effective care coordination, and navigate complex regulatory environments. Candidates must have a nursing degree, valid license, and significant experience in managed care. The role demands strong leadership, analytical skills, and a commitment to improving care for members in accordance with regulatory standards.