Part Time Prior Authorizations Nurse (RN) (Temporary)

Central California Alliance for Health; United States; Hybrid; USD 72,000 - 79,000; Part time

Benefits offered by this job

Medical, Dental and Vision Plans

Paid Time Off

401(a) Retirement Plan

457 Deferred Compensation Plan

Hybrid work environment

Job summary

Central California Alliance for Health is seeking a registered nurse for a temporary Utilization Management role. The position supports prior authorization processes and UM Care Programs, with a focus on accuracy and regulatory compliance.

The role requires a California RN license, a nursing degree, and knowledge of managed care and CMS guidelines. This temporary assignment offers hybrid work arrangements and variable hours, with potential for extension based on business needs.

Qualifications

• Bachelor’s degree in Nursing required.
• Current unrestricted California RN license.
• Working knowledge of managed care and CMS guidelines.

Responsibilities

• Ensure prior authorization reviews meet contract requirements.
• Participate in Utilization Management Care Programs.

Skills

Utilization management

Nursing knowledge

Data interpretation

Policy interpretation

Education

Bachelor's degree in Nursing

Registered Nurse license (CA)

Tools

Excel

PowerPoint

Database software

Job description

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration.That’swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission ofaccessible, quality health care guided by local innovationleadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

ABOUT THIS TEMP POSITION

This is a temporary position. The length of the assignment is estimated to go to the end of 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 temporary assignment open to 20 to 40 hours a week, Monday-Friday.

WHAT YOU'LL BE RESPONSIBLE FOR

• Ensures that prior authorization requests are completed in amanner that meetscontractual requirements and that allprior authorizationreviews are conducted using nationally recognized andevidence-basedstandards
• Participates in the Utilization Management (UM) Care Programs

WHAT YOU'LL NEED TO BE SUCCESSFUL

• 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:
  • Prior Authorization principles and practices
  • Principles and practices of clinical nursing
  • MCG Guidelines in review determination process
  • Medi-Cal program and related regulations and 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’sdegree in Nursingand aminimum of fiveyears of experience in a patient care settingwhich included aminimumof one yearof the required experience in Utilization Management or Case Management(aBachelor’sdegree may substitute for two years of the required experience);or anequivalentcombination 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 - $57.50Typical 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- $54Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to answer any questions that you have or share the applicable pay zone for your location if it’s not one of the typical areas listed.

The posted hiring ranges represent a good‑faith estimate of what a temporary employee would be paid on this assignment. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

OUR 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
• 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.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. 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.