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Temporary Prior Authorizations Nurse (RN)

extra holidays

Remote:

Full Remote

Work from:

California (USA)

Offer summary

Qualifications:

Bachelor’s degree in Nursing, Minimum of three years experience in patient care setting.

Key responsabilities:

Complete prior authorization requests timely
Conduct reviews using evidence-based standards

Central California Alliance for Health SME https://www.thealliance.health/

501 - 1000 Employees

See more Central California Alliance for Health offers

Job description

ABOUT THIS TEMP POSITION

This is a temporary position and the length of the assignment is estimated to through the summer. The length of the assignment is always dependent on business needs and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.

WHAT YOU'LL BE RESPONSIBLE FOR

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

WHAT YOU'LL NEED TO BE SUCCESSFUL

Knowledge of:

Current working 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
- use MS Word
- evaluate medical records and other health care data
Education and Experience:
- 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
- Current unrestricted license as a Registered Nurse issued by the State of California

To read the full position description, and list of requirements click here.

OTHER DETAILS

While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process
This is a temporary position, and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed)

Santa Cruz County Pay Range

$51—$53 USD

Merced County Pay Range

$46.50—$48.50 USD

Monterey County Pay Range

$51—$53 USD

OUR BENEFITS

Medical, Dental and Vision Plans
Ample Paid Time Off
12 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
Onsite EV Charging Stations

ABOUT US

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 members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

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.