Prior Authorizations Nurse (RN) (Temporary)
About The Position
The Prior Authorizations Nurse ensures prior authorization requests are completed in accordance with contractual requirements and that reviews use nationally recognized, evidence-based standards. The position participates in Utilization Management (UM) Care Programs and reports to the Utilization Management Supervisor. This is a full-time, 40-hour-per-week temporary assignment estimated to run from August through the end of December 2026, subject to business needs and change. The employee would work at the Alliance but would be employed by a temporary staffing agency. The organization has a hybrid work environment; interviews are expected to take place remotely via Microsoft Teams. Quarterly company-wide events or department meetings are expected, and in-office or in-community presence may be required depending on business needs. The position does not provide the benefits listed in the posting; temporary employees may have separate benefit options through the staffing agency. The posted hourly hiring range is $52–$57.50 for Zone 1 and $49–$54 for Zone 2. The applicable range depends on work location and other compensation factors. The Alliance is a regional Medi-Cal managed care plan serving members in Mariposa, Merced, San Benito, and Santa Cruz counties, among others.
Requirements
- Hold a current, unrestricted Registered Nurse license issued by the State of California.
- Have an 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, or an equivalent combination of education and experience may qualify.
- Be currently authorized to work in the United States on a full-time, ongoing basis without current or future employer-sponsored sponsorship.
- 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, clinical nursing principles and practices, MCG Guidelines in the review determination process, and the Medi-Cal program and related regulations, including 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 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
- The posting states temporary employees on assignment at the Alliance do not receive the benefits listed; staffing-agency employees may have separate benefit options. Listed standard benefits include medical, dental, and vision plans; paid time off; 12 paid holidays per year; a 401(a) retirement plan; a 457 deferred compensation plan; a health and wellness program; and onsite EV charging stations.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
