Sr. Director, Prior Authorization Clinical, RN - West Hills

RN Job Sr. Director, Prior Authorization Clinical, RN - West Hills Shift Full Time Pay Range $160,000 year to $180,000 Job ID

UHM-5622

Location West Hills, CA, 91304 Job Description The Sr. Director, Prior Authorization Clinical oversees prior authorization nurse case managers, support staff, claims review nurses, and UM compliance staff to ensure quality, cost-effective, patient-centered care in compliance with UM policies, regulatory requirements, and established standards. Responsibilities include staff supervision, program development, policy implementation, workflow improvement, quality assurance, performance evaluation, compliance monitoring, issue resolution, reporting, and collaboration with medical directors and clinical leadership. The role requires knowledge of CMS and ICE utilization management policies, procedures, and timeliness standards, along with proven management, program oversight, and team leadership experience. Project management experience is preferred. Qualifications Education and Licensure: Graduate of an accredited Registered Nursing program with a current, active RN license. Experience: 5+ years of progressive experience in prior authorization or related healthcare operations within a medical group, IPA, or management company, including claims experience and staff supervision and performance management. Leadership and Project Management: Proven ability to develop high-performing teams, lead project development and implementation, monitor productivity, and manage competing priorities and deadlines. Regulatory Knowledge: Demonstrated knowledge of CMS, DMHC, DHS, and major California health plan requirements. About The Hospital As one of the largest physician-led networks in Southern California, we have thousands of physicians and hundreds of hospitals committed to providing quality healthcare to all of the communities we serve. Every day, our employees are inspired to make a difference in the lives of others as well as transform their own experiences to achieve a higher sense of fulfillment. Our employees become a part of an extraordinary team of people dedicated to health, wellness, and happiness for themselves and others. There is no greater reward than contributing to a positive work environment where compassion, understanding, care and attention are encouraged and valued. #J-18808-Ljbffr Working Nurse