Prior Authorizations Nurse RN Part-Time

Profile

We have an opportunity to join the Alliance as a part-time Prior Authorizations Nurse (RN) in the Utilization Management and Complex Case Management Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Utilization Management Supervisor - Prior Authorizations (RN), you will 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
ABOUT THE TEAM
We determine medical necessity and benefit coverage for our members based on industry standards.
THE IDEAL CANDIDATE
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here.
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
Ability to evaluate medical records and other health care data
Education and Experience:
Current unrestricted license as a Registered Nurse issued by the State of California
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
OTHER DETAILS
While this position is connected to one of our Alliance offices, we are in hybrid telecommute work environment right now and we anticipate that the interview process will take place remotely.
Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.
COVID-19 Vaccine Requirement:
At this time, this position requires vaccination or regular testing upon office entry. Fully vaccinated and boosted is defined as receipt of the second dose in a 2-dose series (Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose. If you state that you are vaccinated, proof of vaccination must be submitted at time of hire.
Additionally, all positions at the Alliance are required to meet these minimum qualifications.
OUR BENEFITS
Medical, Dental and Vision Plans
Ample Paid Time Off
11 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
Onsite EV Charging Stations
And many more
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at **MEMBERS ONLY**SIGN UP NOW***. (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Company info

Sign Up Now - WashingtondcCrossing.com