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

Part-time

2 weeks ago

Registered Nurse

DaVita Kidney Care Grass Valley, CA

$43 - $60 / hour

Posting Date 04/30/2026 155 Glasson Way, Grass Valley, California, 95945-5723, United States of America Make a meaningful impact in acute care nephrology. DaVita is seeking an RN to provide dialysis care in a hospital setting for patients with end-stage renal disease and chronic kidney conditions. This is a fast-paced, highly collaborative role where you’ll work directly with patients in ICU, CCU, ED, and other acute care units. What You’ll Do: Deliver inpatient dialysis therapies, including hemodialysis, peritoneal dialysis, CRRT, and apheresis Collaborate with hospital teams and DaVita clinical staff Monitor patients, adjust treatment, and ensure quality outcomes Support and oversee patient care with the help of PCTs Adapt quickly in a dynamic hospital environment What to Expect: No dialysis experience required—paid training provided Work in a variety of hospital units and rotate between facilities as needed Schedule includes regular and on-call shifts, including weekends and holidays Daily schedules may change based on patient needs Requirements: Current RN license in the state of practice ADN required; BSN preferred ICU, CCU, ER, or Med/Surg experience helpful but not required CNN/CDN certification (preferred) Must pass a color vision test (accommodations available) Full vaccination against COVID-19 may be required by hospitals in this program, which may include a booster when eligible. What We Offer: Medical, dental, vision, 401(k) match Paid time off and PTO cash-out Family support: parental leave, EAP, child/elder care, Headspace, and more Pet insurance Joint Commission–accredited inpatient program Career development and training opportunities Be part of a clinical leader in kidney care. Apply today to deliver critical, life-sustaining care in a hospital setting. #LI-CM7 At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic. This position will be open for a minimum of three days. The Wage Range for the role is $43.00 - $60.00 per hour. For location-specific minimum wage details, see the following link: DaVita.jobs/WageRates Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at https://careers.davita.com/benefits Colorado Residents: Please do not respond to any questions in this initial application that may seek age-identifying information such as age, date of birth, or dates of school attendance or graduation. You may also redact this information from any materials you submit during the application process. You will not be penalized for redacting or removing this information.

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

Part-Time Mental Health Registered Nurse (RN)

UHS Sacramento, CA

Responsibilities Heritage Oaks Hospital is part of the UHS Family of Providers which has been highly regarded as an integral part of the greater Sacramento and Northern California mental health system since 1988. Conveniently located in northern Sacramento, Heritage Oaks is a fully accredited, 125-bed acute psychiatric hospital offering a full range of individually tailored treatment services to adolescents, adults, and senior adults, including treatment for substance abuse and chemical dependency issues with drugs and alcohol. Heritage Oaks is a Medicare provider in addition to contracts with most commercial health insurance plans. We are committed to providing service excellence to all and ensuring our patients receive the optimal level of care that will be most beneficial to their health and recovery. Website: https://heritageoakshospital.com/ The Mental Health Registered Nurse (RN) is a licensed professional responsible for delivering comprehensive, patient‑centered psychiatric nursing care in an inpatient behavioral health environment. The RN performs ongoing assessments, develops individualized plans of care, implements therapeutic interventions, and evaluates patient responses. This role requires strong clinical judgment, crisis‑management skills, and the ability to maintain a safe, structured, and recovery‑oriented milieu for patients experiencing acute and chronic psychiatric conditions. Conduct environmental rounds, safety checks, and contraband assessments in accordance with policy. Identify changes in patient condition, including behavioral escalation, medical instability, or safety concerns, and intervene promptly. Implement evidence‑based nursing interventions, including de‑escalation, crisis intervention, limit‑setting, and psychotherapeutic communication. Utilize appropriate interventions during psychiatric and medical emergencies, including code response, HWC physical interventions, and rapid assessment. Maintain a safe, therapeutic, and recovery‑oriented environment for patients with acute and chronic psychiatric conditions. Manage patient assignments consistent with established staffing standards, including a typical 1:6 ratio, modified based on acuity and clinical judgment. Document interventions and patient progress toward treatment goals in a clear, timely, and clinically relevant manner. Support discharge planning by identifying patient needs, barriers, and required follow‑up services. Heritage Oaks offers comprehensive benefits such as: Competitive Compensation Excellent Medical, Dental, Vision, and Prescription Drug Plan Generous Paid Time Off 401(K) with company match and discounted stock plan Career development opportunities within UHS and its Subsidiaries Education Assistance Challenging and rewarding work environment Qualifications Education: Graduate from an accredited program of professional nursing required; Bachelor's Degree preferred. Preferred Experience: Minimum of three (3) years’ psychiatric nursing experience preferred. Demonstrated competency in assessment, crisis intervention, therapeutic communication, and milieu management. Licensure: Current California RN license. Current CPR certification. Completion of Handle with Care (HWC) training, including seclusion/restraint competencies, within 30 days of hire. Successful completion of medication‑administration and developmental‑competency exams. Additional Requirements: Ability to adapt to changing patient needs, acuity levels, and assignments. Ability to work collaboratively within an interdisciplinary team. Strong written and verbal communication skills. Ability to maintain composure and clinical effectiveness in high‑stress situations. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 96,700 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. Avoid and Report Recruitment Scams At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

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