Part Time Prior Authorizations Nurse (RN) (Temporary)
About The Position
This temporary assignment is open for 20 to 40 hours per week, Monday through Friday, and is estimated to continue through the end of December 2026, subject to business needs and possible changes. The person hired would work at the Alliance but would be employed by a temporary employment agency arranged through the Alliance. The position reports to the Utilization Management Supervisor and supports prior authorization reviews and Utilization Management Care Programs. The Alliance operates in a hybrid work environment. The interview process is expected to take place remotely via Microsoft Teams. Some staff may work fully remotely, but attendance at quarterly company-wide events or department meetings is expected. In-office or in-community presence may be required depending on business needs. Temporary employees on assignment do not receive the benefits listed in the posting; the staffing agency may offer separate benefit options.
Requirements
- Current unrestricted Registered Nurse license issued by the State of California.
- Associate’s degree in Nursing and at least five years of experience in a patient care setting, including at least one year of Utilization Management or Case Management experience; a Bachelor’s degree may substitute for two years of the required experience. An equivalent combination of education and experience may qualify.
- Ability to evaluate medical records and other health care data.
- Ability to interpret, apply, and explain policies, regulations, terms, and procedures.
- Ability to maintain organized and accurate records.
- Knowledge of prior authorization principles and practices.
- Knowledge of clinical nursing principles and practices.
- Knowledge of MCG Guidelines in the review determination process.
- Knowledge of the Medi-Cal program, related regulations, and Title 22 regulations.
Nice To Haves
- Bachelor’s degree in Nursing.
- Working knowledge of managed care, Medicare D-SNP and Medi-Cal programs, and related regulations.
- Working knowledge of Centers for Medicare & Medicaid Services (CMS) guidelines, including applicable Local Coverage Determinations and National Coverage Determinations.
- Working knowledge of Microsoft Excel, PowerPoint, and database software.
- Some knowledge of health care providers in the Alliance service area counties.
Responsibilities
- Ensure prior authorization requests are completed in a manner that meets contractual requirements.
- Conduct prior authorization reviews using nationally recognized and evidence-based standards.
- Participate in Utilization Management (UM) Care Programs.
Benefits
- Benefits listed in the posting do not apply to this temporary position. Temporary employees may have separate benefit options through the staffing agency.
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What This Job Offers
Job Type
Part-time
Education Level
Associate degree
