Remote Utilization Review Rn Jobs in Irvine, CA (NOW HIRING)

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors." Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen-not dilute-our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

*This is a remote role that will work Pacific Time Zone business hours*

Oversee daily operations and activities performed by non-clinical staff, including Prior Authorization, Hospital Notification, and Concurrent Review support, to ensure the provision of appropriate utilization of services and efficient and quality service to members and providers.

You Will

• Supervise and coordinate day-to-day operations of the Medical Management department non-licensed staff

• Demonstrate oversight of the authorization process, hospital notification and census management

• Complete quality review and auditing to ensure compliance with all regulatory and compliancestandards

• Support ongoing department process improvements through the PDSA practice by timelycommunication and education to the team

• Ensures staff success by timely communication of job expectations and monitoring of goal progressby coaching and counseling employees; initiating, coordinating, and enforcing systems, policies,and procedures

• Maintain staff by recruiting, selecting, orienting, and training employees; maintaining a safe andsecure work environment; developing personal growth opportunities

• Build effective professional relationships with providers and other internal and external partners byusing excellent verbal and written communication skills, developing trust, meeting timelines,
  respecting cultural differences, using active listening skills, and maintaining confidentiality

• Promote compliance with and adheres to all regulatory and quality standards including but notlimited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health
  Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies' standards such as the National Committee for Quality Assurance (NCQA) as it relates to Medical
  Management's activities

• Supervisory Responsibilities Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)

• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

• Actively support the achievement of SCAN's Vision and Goals.

• Other duties as assigned.

Your Qualifications

• Associate's Degree or equivalent experience

• 2-3 years of related experience in a Medicare Advantage Health Plan Utilization Management

• At least 1 year of leadership experience

• Knowledge of the field's policies, procedures, and practices

• Leads and directs the work of other employees

• Leadership - Basic skills to develops others

• Problem Solving - Basic problem-solving skills

• Communication - Good communication and interpersonal skill

What's in it for you?

• Base salary range: $70,304 to $84,143 per year

• Work Mode: Remote

• An annual employee bonus program

• Robust Wellness Program

• Generous paid-time-off (PTO)

• 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday

• Excellent 401(k) Retirement Saving Plan with employer match and contribution

• Robust employee recognition program

• Tuition reimbursement

• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)