Utilization Management RN Lead — Care Optimization & Compliance

WelbeHealth, LLC.; Los Angeles (CA); On-site; USD 99,000 - 131,000; Full time

Benefits offered by this job

Medical insurance (Medical, Dental, VY

401K savings + match

PTO - 17 days

12 holidays observed annually

Advancement opportunities

Job summary

WelbeHealth, LLC. is seeking an Utilization Management RN Supervisor in Los Angeles to lead the UM team and drive efficient care delivery. You will supervise daily operations, review medical necessity authorizations, and mentor staff while collaborating with internal and external providers.

The role offers a comprehensive benefits package and a base salary with bonus potential, reflecting experience and qualifications. Vaccination policy applies to all employees.

Qualifications

• Minimum of three (3) years of relevant clinical nursing experience.
• Two (2) years of supervisory experience with aptitude to mentor staff.
• Strong preference for prior PACE experience (if stated).

Responsibilities

• Direct oversight of day-to-day operations within the designated UM team.
• Assist the team in reviewing prior-authorization requests for medical necessity and appropriateness.
• Identify, develop, and provide orientation and competency development for staff processing and/or reviewing authorizations.
• Collaborate with providers, clinical staff, and others to timely resolve utilization management issues.

Skills

Nursing experience

Supervisory experience

Utilization Management

Staff coaching

Job description

WelbeHealth, LLC. is seeking an Utilization Management RN Supervisor in Los Angeles to lead the UM team and drive efficient care delivery. You will supervise daily operations, review medical necessity authorizations, and mentor staff while collaborating with internal and external providers.

The role offers a comprehensive benefits package and a base salary with bonus potential, reflecting experience and qualifications. Vaccination policy applies to all employees.