Utilization Management Nurse

ABOUT THIS TEMP POSITION

This is a temporary position. The length of the assignment is estimated to go from August to December 2026, but this is always dependent on business need, and these dates may change. While the assignment would be at the Alliance, you would be an employee of a temporary employment agency that we would connect you with if hired for this position.This is a full-time (40 hours/week) temporary assignment.

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

• Performs concurrent or post-service (retrospective) review of acute in-patient care services using established criteria 

• Participates in the Utilization Management (UM) Care Programs

WHAT YOU'LL NEED TO BE SUCCESSFUL

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

• Desirable Qualifications
  • 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

• Knowledge of:
  • Utilization Management, and/or Case Management principles and practices
  • Principles and practices of clinical nursing
  • MCG Guidelines in review determination process
  • Medi-Cal program and related regulationsand Title 22 regulations
• Ability to:
  • Evaluate medical records and other health care data
  • Interpret, apply, and explain policies, regulations, terms, and procedures
  • Maintain organized and accurate records
• 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 fiveyears of experience in a patient care setting which included a minimum of one year of experience in Utilization Management or Case Management (a Bachelor’s degree may substitute for two years of the required experience);or an equivalent combination of education and experience may be qualifying

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.
• 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: $52 - $57.50
  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: $49- $54
  Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)