RN Supervisor, Appeals, Managed Care, UM

Location: Remote within the United States; California RN licensure is strongly preferred, and California RN license approval and background check are required before starting for applicable candidates.

Salary: $75,300–$135,400 per year

Company

hirify.global provides healthcare services focused on improving access to effective care for individuals, families, and communities.

What you will do

• Supervise clinical review nurses handling prior authorization, concurrent review, and retrospective review.
• Monitor utilization management resources and team performance against compliance, quality, efficiency, and service standards.
• Collaborate with clinicians, providers, members, and senior management to resolve complex care issues.
• Maintain and apply regulations, accreditation standards, utilization management principles, and industry best practices.
• Develop and implement utilization management policies, procedures, guidelines, and quality improvements.
• Coach, evaluate, onboard, hire, and train utilization management team members while leading change initiatives.

Requirements

• Graduate of an accredited nursing school or bachelor's degree with at least 4 years of related experience.
• Registered Nurse state licensure or compact state licensure is required.
• Remote candidates may reside in any US state; an active California RN license is strongly preferred.
• For Health Net Federal Services roles, US citizenship and a current National Agency Check government security clearance are required.
• For applicable Health Net Federal Services roles, current active licensure or certification permitting independent assessment is required.
• Certified Managed Care Nurse certification is required within 1.5 years for Health Net Federal Services Medical Management.

Nice to have

• Three to five years of direct experience with appeals and utilization management in managed care or MCO environments.
• Strong knowledge of appeals and utilization management principles.

Culture & Benefits

• Health insurance and comprehensive employee benefits.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Paid time off and holidays.
• Flexible remote, hybrid, field, or office work schedules, subject to role and program eligibility.