Travel Nurse RN - Utilization Review
Costa Mesa, CA
HonorVet Technologies
5x8 hrs, Days
Referral Bonus

UM Nurse Manager – Direct Hire (Remote)
Client: Hoag Memorial Hospital Presbyterian
Department: Hoag Clinic Utilization Management (87615)
Location: Costa Mesa, CA (Remote Role)

Assignment Details

• Schedule: Monday–Friday | 8 AM–5 PM
• Hours: 40 hrs/week
• Work Type: 100% Remote
• On-Call: Required
• Employment Type: Direct Hire
• Reports To: UM Director
• Team Size: 15 (RNs & Non-Clinical Staff)

Compensation

• Expected Pay Range: $65.67/hr 

Position Summary

The UM Nurse Manager oversees utilization management operations, ensuring regulatory compliance, staff performance, and high-quality care delivery. This leader serves as the subject-matter expert for UM processes, manages escalations, supports audits, and drives process improvement initiatives.

Key Responsibilities

• Lead and train UM staff on medical necessity reviews and authorization workflows
• Ensure compliance with federal, state, health plan, and accreditation standards (URAC, NCQA)
• Conduct performance evaluations and support staff development
• Oversee accurate documentation in medical management systems
• Collaborate with hospital teams, providers, and Medical Directors
• Monitor referral trends and inappropriate authorizations
• Manage complex cases and high-risk members
• Support discharge planning and post-acute coordination
• Serve as UM SME for clinical criteria (MCG, NCCN, LCD/LCA, etc.)
• Participate in UM committee meetings and audits
• Drive quality improvement initiative

Required Qualifications

• Active California RN License
• Bachelor’s Degree in a Healthcare-Related Field
• 5–10 years of clinical nursing experience
• 3–5 years in nursing leadership/management
• Prior authorization experience in ambulatory or health-plan settings
• Experience managing UM in California
• Audit experience in UM
• Strong analytical, communication, and leadership skills
• Proficiency with MS Office

Preferred Qualifications

• 2–3 years of UM Manager experience
• Experience in medical groups, hospitals, or risk-based MSOs
• Familiarity with Epic Tapestry and MCG (training provided)