California Licensed Utilization Management RN

Serving as a subject matter expert in prior authorization and letter review processes, the remote Team Lead - UM Regulatory & Compliance, RN will manage daily operations of clinical staff, ensure adherence to regulatory standards, and collaborate with leadership to drive quality initiatives in a full-time capacity. Key responsibilities Oversee daily operations of the Utilization Management team and ensure compliance with regulatory standards Act as a first-line resource for clinical staff, providing guidance on UM processes and addressing issues as they arise Collaborate with leadership to implement LEAN project initiatives and monitor UM metrics for continuous improvement Required qualifications Associate's degree in nursing from an accredited institution; Bachelor's degree preferred A minimum of three years of experience in clinical utilization management processes At least two years of direct clinical patient care experience in an acute care facility with an active RN license Advanced knowledge of UM policies, regulations, and nationally recognized criteria Bilingual (English/IEHP Threshold Language) skills preferred