RN Supervisor UM Prior Auth

Job Summary and Responsibilities As the Supervisor of Utilization Management (UM), under the guidance and supervision of the department Manager/Director, you will be responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical Group through an interdisciplinary process that provides a clinical and financial approach through the continuum of care. Promoting the quality and cost effectiveness of medical care by ensuring department staff are applying clinical acumen and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision, this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory guidelines. Responsible for day to day operations of the Pre-Authorization team to include timely response and appropriate evaluation of referral reviews, correct selection of criteria, accurate prep to the UM Physician reviewer when indicated, timely verbal and written documentation, and completion of the file. Ensures adequate staffing and assignments and adjusts workflow as needed to meet department goals. Manages team schedule including requests for time off and assurance of coverage during physician office hours. Organizes, structures, and chairs a minimum of one pre-authorization meeting per month, including other staff as appropriate. Motivates and coaches staff to include new-hire training, problem solving, and special projects. Assists manager with performance activities to include monitoring, coaching, educating, and providing feedback to team. Ensures UM Physicians are provided the relevant information needed to accurately review a referral. Fosters the relationship between the Pre- Authorization team and the Medical Director and Physician Reviewers. Tracks cost savings from activities over time to evaluate success of programs. Maintains or removes programs based on organization and department goals. Develops reports for leadership as required. ***This position is hybrid, work-from-home and in-clinic/office. ***This position will work rotating weekends. Job Requirements Minimum Qualifications: - 5+ years clinical experience. - 3+ years Utilization experience in health plan/UM operations, Acute or subacute utilization review. - Bachelors degree, or equivalent experience. - Clear and current CA Registered Nurse (RN) license. - Ability to demonstrate leadership and management skills. - Knowledge of all applicable federal and state regulations as well as accreditation standards. - Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory requirements. - Must have the ability to monitor, compile, report and analyze data/statistics. - Requires excellent human relations, interpersonal and oral/written communication skills. - Able to recognize and address the needs and concerns of customers. - Ability to interact with all levels of the organization as well as with external contacts. - Requires good knowledge and skills with Microsoft Office (ie: Word and Excel) and other computer information systems and applications. Preferred Qualifications: - 7 years UM experience with Charge/Lead/Supervisory/Management experience in Utilization Management department preferred. - Experience working with health plan auditors preferred. - Working knowledge of InterQual preferred. - Knowledgeable of NCQA and ICE preferred. Where You'll Work Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service. One Community. One Mission. One California

RN

School

Full-time

1 week ago

SCHOOL NURSE (Student Support and Health Services)

Elk Grove Unified School District Elk Grove, CA

The Elk Grove Unified School District (EGUSD) is the fourth-largest school district in California located in southern Sacramento County. EGUSD covers 320 square miles and includes 68 schools: 43 elementary schools, nine middle schools, nine high schools, five alternative education schools, an adult school, one charter school and a virtual academy. Offering a multitude of educational programs, including over 60 career-themed academies and pathways within 13 industry sectors, we prepare our students for college and career by supporting them with the means to be creative problem solvers; self-aware, self-reliant, and self-disciplined; technically literate; effective communicators and collaborators; and engaged in the community as individuals with integrity. We integrate rigorous academics with career-based learning and real world workplace experiences and ensure that Every Student is Learning, in Every Classroom, in Every Subject, Every Day to Prepare College, Career and Life Ready Graduates. Job Description / Essential Elements: ELK GROVE UNIFIED SCHOOL DISTRICT CLASS TITLE: SCHOOL NURSE BASIC FUNCTION: Under the direction of the Assistant Superintendent-Student Services, provide school health and nursing services to students; promote health and prevention education and safety; serve as a technical and health education resource to students, personnel and the community. ESSENTIAL FUNCTIONS: Provide school health and nursing services to students; conduct medical case finding and screening for vision, hearing, scoliosis and other health defects; provide emergency care for ill or injured students. Promote health and prevention education and safety; conduct staff education and in-service training meetings related to specialized health conditions, procedures, medications and other issues. Serve as a technical and health education resource to students, personnel and the community; respond to inquiries and provide information; communicate the condition of students with health liabilities to teachers; provide health charts and related information as necessary. Provide consultation and assist school staff, students and families with communicable disease control, first aid, personal hygiene, student health assessments and school site health and safety assessment; evaluate student immunization status at appropriate grade levels. Collect, prepare and maintain a variety of records and reports related to student health and assigned activities; establish and maintain filing systems. Assist the Special Education program with developing Individual Educational Programs for disabled students; assess home environments and student needs. Train and provide work direction and guidance to assigned clerical staff. Operate and maintain a variety of specialized medical equipment; assure proper working condition of equipment; operate standard office equipment including a computer and assigned software. Attend assigned meetings and conferences. Process child abuse referrals according to established procedures and regulations as directed. Perform related duties as assigned. DEMONSTRATED KNOWLEDGE AND ABILITIES: KNOWLEDGE OF: Medication effects and proper administration procedures. Proper operation of specialized health assessment instruments. Modern medical terminology, equipment and techniques. Accepted methods and principles of personal hygiene. Diagnostic methods for medical conditions and diseases. Accepted testing techniques for hearing, vision, scoliosis and other screenings. Oral and written communication skills. Interpersonal skills using tact, patience and courtesy. Health and safety regulations. Record-keeping and report preparation techniques. Operation of standard office equipment including a computer and assigned software. First aid and CPR procedures. ABILITY TO: Provide school health and nursing services to students. Promote health and prevention education and safety. Serve as a technical and health education resource to students, personnel and the community. Screen students for vision, hearing, scoliosis and other problems. Train and provide health information to parents, students and staff. Communicate effectively both orally and in writing. Establish and maintain cooperative and effective working relationships with others. Learn District organization, operations, policies and objectives. Learn department and program objectives and goals. Plan and organize work. Analyze situations accurately and adopt an effective course of action. Observe health and safety regulations. Administer first aid and CPR. Maintain records and prepare reports. Operate standard office equipment including a computer. Maintain consistent, punctual and regular attendance. Move hands and fingers to operate medical equipment and a computer keyboard. Hear and speak to exchange information. See to read a variety of materials. EDUCATION AND EXPERIENCE REQUIRED: Any combination equivalent to: bachelor's degree in nursing, health education or related field and one year of health profession experience. LICENSES AND OTHER REQUIREMENTS: Valid American Red Cross Community CPR and Standard First Aid Instructor Certificate. Preliminary or Professional Clear School Nurse credential. Public Health Certificate. WORKING CONDITIONS: ENVIRONMENT: Office environment. Requirements / Qualifications Requirements Please complete our on-line application. Please scan and attach all required documents. PLEASE BE AWARE THAT ANY REQUIRED DOCUMENTS TO BE SCANNED AND ATTACHED MUST BE IN .PDF FORMAT. Valid California School Nurse Services Credential. Valid CA Registered Nurse License. CPR/First Aid Certification (Valid American Red Cross CPR Standard First Aid Instructor Certificate) Credential Copy (Copy of all current valid credentials from CTC website (print information from each individual credential screen then scan and upload - do not use the email documents option as it does not contain all the needed information) ) Letter(s) of Recommendation (Three (3) Current Letters of Recommendations - Letters must be signed.) Resume Comments and Other Information For your Credential Copy attachment, please be sure to attach the copy of the CTC page which states your credential expiration date as well as the specific subject matter for the credential (NOT the Certificate of Clearance). Out of State Credentialed Applicants: Please attach appropriate out of state credential. Bachelor's degree in Nursing. Nondiscrimination Statement: The Elk Grove Unified School District (District) is committed to providing equal opportunity for all individuals in District programs and activities. District programs, activities, and practices shall be free from unlawful discrimination, including discrimination against an individual or group based on race, color, ancestry, nationality, national origin, immigration status, ethnic group identification, ethnicity, age, religion, marital status, pregnancy, parental status, physical or mental disability, sex, sexual orientation, gender, gender identity, gender expression, or genetic information; a perception of one or more of such characteristics; or association with a person or group with one or more of these actual or perceived characteristics. For questions or complaints concerning student against student incidents, please contact: Jenifer Avey, Assistant Superintendent, PreK-6 Education/Title IX Coordinator - 9510 Elk Grove Florin Road, Elk Grove, CA 95624, (916) 686-7795 x 67125 |TitlelX@egusd.net or Chad Sweitzer, Assistant Superintendent, Secondary Education/Title IX Coordinator - 9510 Elk Grove Florin Road, Elk Grove, CA 95624, (916) 686-7795 x 67118 |TitlelX@egusd.net. For questions or complaints concerning employees, please contact: Elena Duenas, HR Compliance Coordinator/Title IX Coordinator - 9510 Elk Grove Florin Road, Elk Grove, CA 95624 | (916) 686-7795 x 67149 |HRCompliance@egusd.net or TitleIX@egusd.net. For questions or complaints concerning Section 504, please contact: Amreek Singh, Executive Director, School Supports/504 Coordinator - 9510 Elk Grove Florin Road, Elk Grove, CA 95624, (916) 686-7568 x 67194 |amrsingh@egusd.net. For questions or complaints concerning facilities, please contact: Robert Teresi, Risk Manager - 9510 Elk Grove Florin Road, Elk Grove, CA 95624 | (916) 686-7775 |rteresii@egusd.net. For questions or complaints concerning educational equity, please contact: Cory Jones, Director of Educational Equity - 9384 Elk Grove Florin Road, Elk Grove, CA 95624 | (916) 831-2041 |cmjones@egusd.net.

School Registered Nurse | Vacaville, California

Soliant Health Vacaville, CA

$35.77 - $55.77 / hour

An exciting contract opportunity is available for a skilled Registered Nurse (RN) to provide critical support in a school setting near Vacaville, CA. This onsite position is ideal for experienced and compassionate professionals interested in working with students and staff, offering health expertise and care that truly makes a difference in young lives. The assignment runs from ASAP through May 27, 2026, with 32.5 hours per week, providing temporary support for the remainder of the school year. The school prefers an RN, but is also open to experienced LVNs eager to make a positive impact. Qualifications: Active California RN license (LVNs with relevant school experience are considered) Previous experience in school nursing or working with pediatric or adolescent populations is highly valued Current CPR/BLS certification Excellent assessment, communication, and organizational skills Ability to work independently, adapting to the dynamic needs of a school environment Responsibilities: Oversee and deliver daily health services to students and staff, including medication administration, first aid, and health counseling Develop, update, and manage individualized health care plans for students as needed Collaborate with educators, families, and external health providers to support students’ well-being Maintain accurate documentation of student health records, treatments, and interventions in accordance with legal and district guidelines Promote a healthy, safe, and supportive school environment by leading wellness initiatives, screenings, care plans, and education programs This contract position provides a rewarding opportunity to connect with students and contribute meaningfully to their success and safety. If you are passionate about school health, ready for a new chapter in your nursing career, and meet the qualifications above, submit your application today to be considered for this role! Embrace the chance to inspire and be inspired in this supportive educational community. Compensation for this position ranges from $35.77 to $55.77. Eligible candidates may also receive healthcare benefits, housing, and meals/incidentals. Full details of our healthcare benefits plan can be found here . This posting is open for 60 days after the posting date.

RN Supervisor UM Prior Auth

Virginia Mason Franciscan Health Rancho Cordova, CA

Job Summary and Responsibilities As the Supervisor of Utilization Management (UM), under the guidance and supervision of the department Manager/Director, you will be responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical Group through an interdisciplinary process that provides a clinical and financial approach through the continuum of care. Promoting the quality and cost effectiveness of medical care by ensuring department staff are applying clinical acumen and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision, this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory guidelines. Responsible for day to day operations of the Pre-Authorization team to include timely response and appropriate evaluation of referral reviews, correct selection of criteria, accurate prep to the UM Physician reviewer when indicated, timely verbal and written documentation, and completion of the file. Ensures adequate staffing and assignments and adjusts workflow as needed to meet department goals. Manages team schedule including requests for time off and assurance of coverage during physician office hours. Organizes, structures, and chairs a minimum of one pre-authorization meeting per month, including other staff as appropriate. Motivates and coaches staff to include new-hire training, problem solving, and special projects. Assists manager with performance activities to include monitoring, coaching, educating, and providing feedback to team. Ensures UM Physicians are provided the relevant information needed to accurately review a referral. Fosters the relationship between the Pre- Authorization team and the Medical Director and Physician Reviewers. Tracks cost savings from activities over time to evaluate success of programs. Maintains or removes programs based on organization and department goals. Develops reports for leadership as required. ***This position is hybrid, work-from-home and in-clinic/office. ***This position will work rotating weekends. Job Requirements Minimum Qualifications: - 5+ years clinical experience. - 3+ years Utilization experience in health plan/UM operations, Acute or subacute utilization review. - Bachelors degree, or equivalent experience. - Clear and current CA Registered Nurse (RN) license. - Ability to demonstrate leadership and management skills. - Knowledge of all applicable federal and state regulations as well as accreditation standards. - Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory requirements. - Must have the ability to monitor, compile, report and analyze data/statistics. - Requires excellent human relations, interpersonal and oral/written communication skills. - Able to recognize and address the needs and concerns of customers. - Ability to interact with all levels of the organization as well as with external contacts. - Requires good knowledge and skills with Microsoft Office (ie: Word and Excel) and other computer information systems and applications. Preferred Qualifications: - 7 years UM experience with Charge/Lead/Supervisory/Management experience in Utilization Management department preferred. - Experience working with health plan auditors preferred. - Working knowledge of InterQual preferred. - Knowledgeable of NCQA and ICE preferred. Where You'll Work Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service. One Community. One Mission. One California

RN Supervisor UM Prior Auth

Dignity Health Rancho Cordova, CA

Job Summary and Responsibilities As the Supervisor of Utilization Management (UM), under the guidance and supervision of the department Manager/Director, you will be responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical Group through an interdisciplinary process that provides a clinical and financial approach through the continuum of care. Promoting the quality and cost effectiveness of medical care by ensuring department staff are applying clinical acumen and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision, this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory guidelines. Responsible for day to day operations of the Pre-Authorization team to include timely response and appropriate evaluation of referral reviews, correct selection of criteria, accurate prep to the UM Physician reviewer when indicated, timely verbal and written documentation, and completion of the file. Ensures adequate staffing and assignments and adjusts workflow as needed to meet department goals. Manages team schedule including requests for time off and assurance of coverage during physician office hours. Organizes, structures, and chairs a minimum of one pre-authorization meeting per month, including other staff as appropriate. Motivates and coaches staff to include new-hire training, problem solving, and special projects. Assists manager with performance activities to include monitoring, coaching, educating, and providing feedback to team. Ensures UM Physicians are provided the relevant information needed to accurately review a referral. Fosters the relationship between the Pre- Authorization team and the Medical Director and Physician Reviewers. Tracks cost savings from activities over time to evaluate success of programs. Maintains or removes programs based on organization and department goals. Develops reports for leadership as required. ***This position is hybrid, work-from-home and in-clinic/office. ***This position will work rotating weekends. Job Requirements Minimum Qualifications: - 5+ years clinical experience. - 3+ years Utilization experience in health plan/UM operations, Acute or subacute utilization review. - Bachelors degree, or equivalent experience. - Clear and current CA Registered Nurse (RN) license. - Ability to demonstrate leadership and management skills. - Knowledge of all applicable federal and state regulations as well as accreditation standards. - Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory requirements. - Must have the ability to monitor, compile, report and analyze data/statistics. - Requires excellent human relations, interpersonal and oral/written communication skills. - Able to recognize and address the needs and concerns of customers. - Ability to interact with all levels of the organization as well as with external contacts. - Requires good knowledge and skills with Microsoft Office (ie: Word and Excel) and other computer information systems and applications. Preferred Qualifications: - 7 years UM experience with Charge/Lead/Supervisory/Management experience in Utilization Management department preferred. - Experience working with health plan auditors preferred. - Working knowledge of InterQual preferred. - Knowledgeable of NCQA and ICE preferred. Where You'll Work Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service. One Community. One Mission. One California

School RN in Davis, CA

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