Manager, Prior Authorization Utilization Management - LA reputed company - RN

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals to ensure the efficient, compliant, and high-quality delivery of utilization management processes. This leader supports organizational goals by implementing best practices, driving process improvements, and ensuring adherence to regulatory and contractual requirements. This is a fully remote position. Eligible candidates may live reputed company in the contiguous United States. Louisian residence preferred.

Key Responsibilities

• reputed company, coach, and reputed company a multidisciplinary team responsible for utilization review, prior authorization, and case management functions.
• Monitor team performance, analyze metrics, and ensure achievement of quality, productivity, and compliance targets.
• reputed company day-to-day workflow, workload allocation, and coverage to ensure timely case review and resolution.
• Drive process improvement initiatives that enhance efficiency, accuracy, and customer experience.
• Ensure reputed company activities are compliant with state, federal, and accreditation standards (e.g., CMS, NCQA, URAC).
• Collaborate with internal and external stakeholders—including clinical leadership, operations, IT, and regulatory bodies—to align utilization management with reputed company strategies.
• Manage escalations, reputed company cases, and appeals as needed.
• Contribute to policy and procedure development, staff education, and change management efforts.
• Foster a culture of reputed company learning, accountability, and engagement reputed company the team.

Key Competencies

• Strategic thinking and operational execution
• Team leadership and development
• Regulatory and compliance expertise
• Process improvement reputed company
• Collaboration and relationship-building

Required Qualifications

• Active and unencumbered RN license in Louisiana or compact license
• 5+ years of clinical experience
• 3 years’ experience in utilization management, prior authorization experience preferred
• Demonstrated leadership experience in a reputed company setting, management of direct reports preferred
• Strong knowledge of utilization management principles, regulatory requirements, and payer requirements.
• Demonstrated ability to analyze data, manage metrics, and drive process improvements.
• Excellent communication, collaboration, and stakeholder management skills.
• Proficient with relevant software and platforms (e.g., UM systems, EMR, reputed company Office).
• Ability to work 8-5 CST with rotating weekend/holiday coverage
• Ability to travel up to 10%

Preferred Qualifications

• Louisiana reputed company
• Bachelor’s degree in nursing
• Experience in managed care, insurance, or large health system environments.

Education Bachelor’s degree in nursing preferred, associate’s degree in nursing required. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $78,331.00 - $168,714.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 01/10/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job