We have two opportunities to join the Alliance as a Prior Authorizations Nurse (RN) in Utilization Management. These positions can be filled in any of our Alliance offices (Merced, Salinas or Scotts Valley).
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Utilization Management Supervisor - Prior Authorizations (RN), you will ensure that prior authorization requests are completed in a timely fashion to meet contractual requirements and that all reviews are conducted using nationally recognized and evidence based standards
ABOUT THE TEAM
We determine medical necessity and benefit coverage for our members based on industry standards.
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here.
- Knowledge of:
- Milliman Care Guidelines in review determination process
- Medi-Cal and related policy and Title 22 regulations
- Utilization management principles and activities
- Case management principles and activities
- Ability to:
- Understand concepts pertaining to prepaid health care
- Demonstrate strong critical thinking and clinical nursing skills
- Ability to evaluate medical records and other health care data
- Education and Experience:
- Current unrestricted license as a Registered Nurse issued by the State of California
- Bachelor’s degree in Nursing and a minimum of three years of experience in a patient care setting which included a minimum of one year of experience in Utilization Management or Case Management; or an equivalent combination of education and experience may be qualifying
- While this position is connected to one of our Alliance offices, we are in a fully telecommute work environment right now due to the COVID-19 pandemic. The interview and on-boarding process for this position will be completed remotely
- This position may require onsite presence when our offices re-open, no sooner than February 1, 2022. Onsite presence will most likely be on a part-time basis, but is dependent on business needs
Additionally, all positions at the Alliance are required to meet these minimum qualifications.
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 11 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- EV Charging Stations
- And many more
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 377,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here.
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.