Utilization Management RN

WelbeHealth•California, USA, CA

1d•$99,310 - $131,089

About The Position

WelbeHealth provides an all-inclusive healthcare option for vulnerable seniors, serving as both a care provider and care plan. The Health Plan Services team supports participants’ care journeys, and the Utilization Management team helps ensure timely, quality, compliant, and cost-effective care. The Utilization Management RN Supervisor guides the team and drives continuous improvement of care delivery processes. This role oversees day-to-day operations for a designated Utilization Management team, supports review of prior-authorization requests, and develops staff orientation and competencies. It collaborates with internal and external providers, clinical staff, and others to resolve utilization management issues in a timely manner. Compensation consists of base salary plus bonus. The stated compensation range is $99,309.58–$131,088.64 USD; actual compensation depends on experience and relevant qualifications. WelbeHealth requires employees to provide proof of vaccination or a vaccine declination form before employment and maintains infection-control and PPE standards.

Requirements

At least three years of relevant clinical nursing experience.
Two years of supervisory experience, with demonstrated aptitude for mentoring and developing team members.

Nice To Haves

Prior PACE experience is strongly preferred.

Responsibilities

Direct oversight of day-to-day operations within the designated Utilization Management 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 internal and external providers, clinical staff, and others to resolve utilization management issues in a timely manner.