[Hiring] Temporary Prior Authorizations Nurse @Central California Alliance for Health

Role Description 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. Reporting to the Utilization Management Supervisor, this position:

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

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

Requirements

• Knowledge of MCG Guidelines in review determination process
• Knowledge of principles and practices of clinical nursing
• Knowledge of Medi-Cal program and related regulations and Title 22 regulations
• Knowledge of 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
• Ability to prepare narrative and statistical reports, correspondence, and other program documents
• Ability to quickly learn and gain expertise in a broad variety of medical records systems
• 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

Benefits

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

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