Step Into a Role That’s All About Purpose, Precision & Impact.
Do you bring a sharp clinical eye, natural leadership instincts, and a commitment to delivering exceptional care? We’re looking for a Registered Nurse to take charge of our Prior Authorization and Utilization Management operations, bringing strategy and structure while rising the bar for excellent care.
Step into a leadership role where skilled nurses, compliance experts, and coordinators come together to deliver fast, precise, patient-first authorizations. If you thrive on collaboration, compliance, and continuous improvement, we want to meet you.
What You’ll Be Doing:
Lead and support a multidisciplinary team of 40, including one direct supervisor, to ensure strong performance and collaboration.
Oversee the prior authorization process with a focus on clinical appropriateness, timely decision-making, and full regulatory compliance.
Ensure robust documentation practices and accurate reporting to support audits, utilization reviews, and compliance initiatives
Collaborate with the Medical Director to develop and execute Utilization Management strategies that drive patient outcomes and cost-effective care.
Stay current on healthcare regulations including CMS, DMHC, ICE, and Medicare Part C & D, while guiding audits, preparing performance reports, and contributing to quality improvement.
Serve as a key cross-functional leader, resolving issues across departments, streamlining workflows, and communicating effectively with physicians, staff, and leadership.
What You Bring:
Licensed RN in California, with graduation from an accredited nursing program.
5+ years of progressive experience in prior authorization, nv, or utilization management, preferably in a medical group, IPA, or managed care setting.
Deep understanding of UM regulations and workflows, including CMS and ICE guidelines.
A balanced mindset, you understand both clinical excellence and operational efficiency, and you know how to lead with both in mind
Proven leadership experience managing teams, driving performance, and navigating fast-paced, high-stakes environments with strong communication skills.
Tech-savvy and analytical, with proficiency in Microsoft Office, project management know-how, and the ability to multitask with precision.
Why You’ll Love It Here:
Lead with impact: drive meaningful change for patients, teams, and clinical systems.
Thrive in a collaborative, growth-minded environment where your voice and ideas are valued.
Take ownership: optimize workflows, improve outcomes, and make your mark on healthcare delivery.
Enjoy competitive perks including employer-paid medical, dental, and pharmacy, 401(k) match, paid time off, tuition support, and more.
Be part of a supportive, business-casual culture that celebrates progress, encourages balance, and offers the flexibility of a hybrid schedule.
Extra Credit If You:
Have professional claims review or coding experience.
Bring energy, empathy, and big-picture thinking to your leadership style.
Know how to inspire teams and get things done, while keeping it fun.
If you're ready to lead with confidence and compassion while driving real change in clinical operations, we’d love to hear from you.