Utilization Review/Prior Auth · Utilization Management RN

Jemma LLC; California; On-site; USD 99,000 - 131,000; Full time

Benefits offered by this job

Health insurance

PTO & holidays

401K match

Advancement opportunities

Job summary

WelbeHealth in California seeks an experienced Utilization Management RN Supervisor to lead the daily UM operations and ensure timely, compliant care for participants.

You will review prior-authorization requests, mentor staff, and collaborate with providers to resolve utilization issues while advancing team competency and performance. This full-time role offers a competitive salary within the stated range and a comprehensive benefits package.

Qualifications

• Minimum of three (3) years of relevant clinical nursing experience.
• Strong preference for prior PACE experience.
• Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team members.

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.

Skills

Nursing

Supervisory experience

Job description

# Utilization Management RNWelbeHealth · CA · Posted todayRNUtilization Review/Prior AuthStaffApply on employer site →Applications happen on the employer's own careers site — Jemma never handles your application.Employer-stated range: $99K–$131K/yr What verified nurses actually earn in this role — visible to verified members.Create a free account →## About this roleAt WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve.Our Health Plan Services team plays a critical role in our participant’s journey and our Utilization Management team ensures we can provide timely, quality, compliant, and cost-effective care to our participants. By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of our care delivery processes.**Essential Job Duties:*** 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 (internal and external), clinical staff, and others to timely resolve any utilization management issues**Job Requirements:*** Minimum of three (3) years of relevant clinical nursing experience* Strong preference for prior PACE experience* Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team members**Benefits of Working at WelbeHealth:** Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.* Medical insurance coverage (Medical, Dental, Vision)* Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and sick time* 401K savings + match* Advancement opportunities - we’ve got a track record of hiring and promoting from within, meaning you can create your own path!* And additional benefitsCompensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.Compensation Offering$99,309.58 — $131,088.64 USD**COVID-19 Vaccination Policy**At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.**Our Commitment to Diversity, Equity and Inclusion**At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.**Beware of Scams**Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to [e-mail]