UM Nurse Manager (Utilization Management) – 100% Remote | California

<p>🚨 <strong>Now Hiring: UM Nurse Manager (100% Remote – California Only)</strong> 🚨</p><p>📍 Remote (Must reside in CA)</p><p> 💼 13 weeks Contract</p><p> 🗓 Start: ASAP</p><p> 🕒 Mon–Fri, 8 AM–5 PM (On-call required)</p><p> 💲 $57.09–$94.18/hr (DOE)</p><p><br></p><p>We are seeking an experienced <strong>Utilization Management (UM) Nurse Manager</strong> to lead a team of 15 (RNs & non-clinical staff). This role serves as the UM SME, manages escalations, ensures regulatory compliance, and oversees prior authorization review processes.</p><p><br></p><p><strong>Key Responsibilities:</strong></p><ul><li>Lead and supervise UM team performance</li><li>Oversee prior authorization reviews (ambulatory & health plan)</li><li>Manage escalations and serve as UM Subject Matter Expert</li><li>Ensure compliance with Federal, State, URAC & NCQA regulations</li><li>Participate in audits and UM committee meetings</li><li>Drive process improvement initiatives</li><li>Collaborate with providers, case management & leadership</li></ul><p><br></p><p><strong>Requirements (MUST HAVE):</strong></p><ul><li>Active <strong>California RN License</strong></li><li>Bachelor’s degree in healthcare-related field</li><li>3–5+ years Nursing Management experience</li><li>5–10+ years total nursing experience</li><li>Strong Prior Authorization experience (ambulatory & health plan required)</li><li>Health Plan experience (Medicare, Medicare Advantage, Commercial, HMO, Medi-Cal/ACA)</li><li>Experience managing UM for California</li><li>UM audits & regulatory compliance experience</li><li>Knowledge of medical necessity criteria (NCD, LCD, LCA, MCG, NCCN)</li><li>Strong leadership & escalation management skills</li></ul><p><br></p><p>📧 Interested? Email: <strong>syed.tahir@peopleintegra.com</strong></p>

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