Prior Authorizations Nurse

ABOUT THIS TEMP POSITION

This is a temporary position, and the length of the assignment is estimated to go through the end of 2026. The length of the assignment is always dependent on business need 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

Reporting to the Utilization Management Supervisor, this position: 

• Ensures that prior authorization requests are completed in a manner that meets contractual requirements and that all prior authorization reviews are conducted using nationally recognized and evidence-based standards

THE IDEAL CANDIDATE

• Bachelor’s degree in Nursing
• Working knowledge of managed care, the 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 and PowerPoint, and database software
• Some knowledge of health care providers in the Alliance service area counties

WHAT YOU'LL NEED TO BE SUCCESSFUL

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

• Knowledge of:
  • MCG Guidelines in review determination process
  • Principles and practices of clinical nursing
  • Medi-Cal program and related regulations and Title 22 regulations, Centers for Medicare & Medicaid Services (CMS) guidelines including applicable Local Coverage Determinations and National Coverage Determination
• Ability to:
  • Evaluate medical records and other health care data
  • prepare narrative and statistical reports, correspondence, and other program documents
  • Quickly learn and gain expertise in a broad variety of medical records systems
• Education and Experience:
  • Current unrestricted license as a Registered Nurse issued by the State of California
  • Associate’s degree in Nursing and a minimum of five years of experience in a patient care setting which included a minimum of one year of experience in Utilization Management or Case Management
  • Experience, or an equivalent combination of education and experience, which would provide the required knowledge, skills and abilities may be qualifying

OTHER INFORMATION

• 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.
• 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). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options.  

COMPENSATION INFORMATION

• Zone 1 Pay Range: $56.00 - $57.88 USD
  Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
  
  
• Zone 2 Pay Range: $52.00 - $54.50 USD
  Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)