Prior Authorizations Nurse RN

We have an opportunity to join the Alliance as a Prior Authorizations Nurse RN in the Utilization Management Department. 

HAT 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:
• 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 and Teams
  • 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 INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).