Prior Authorization Nurse (RN)

Central California Alliance for Health; California (MO); Hybrid; USD 60,000 - 100,000; Full time

Job summary

Join a forward-thinking organization as a Prior Authorization Nurse (RN) in Utilization Management. This hybrid role offers the opportunity to work remotely while ensuring that prior authorization requests are completed timely and accurately. You will be part of a dedicated team that assesses medical necessity and benefit coverage based on industry standards. With a commitment to diversity and equal employment opportunity, this organization provides a supportive environment for professional growth. If you're looking to make a difference in healthcare, this role is perfect for you.

Benefits

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement plans

Wellness programs

Onsite EV charging stations

Qualifications

• Current California RN license required.
• Bachelor's degree in Nursing with 3+ years of patient care experience.

Responsibilities

• Ensure timely completion of prior authorization requests.
• Assess medical necessity and benefit coverage for members.

Skills

Critical thinking

Clinical nursing skills

Evaluating medical records

Understanding prepaid health care concepts

Education

Bachelor's degree in Nursing

Current California RN license

Job description

Prior Authorization Nurse (RN)

Location: Remote in California

Join the Alliance as a Prior Authorization Nurse (RN) in Utilization Management. This role can be based in any of our offices in Merced, Salinas, or Scotts Valley.

Responsibilities

Under the supervision of the Utilization Management Supervisor - Prior Authorizations (RN), you will ensure timely completion of prior authorization requests, adhering to contractual requirements and using nationally recognized, evidence-based standards.

About the Team

Our team assesses medical necessity and benefit coverage for members based on industry standards.

Qualifications

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

• Knowledge of:
  • Milliman Care Guidelines for review determination
  • Medi-Cal policies and Title 22 regulations
  • Utilization and Case Management principles
• Skills:
  • Understanding prepaid health care concepts
  • Critical thinking and clinical nursing skills
  • Evaluating medical records and healthcare data
• Education & Experience:
  • Current, unrestricted California RN license
  • Bachelor's degree in Nursing with at least three years' patient care experience, including one year in Utilization or Case Management, or equivalent combination of education and experience

Additional Information

• Work is hybrid; interviews via Microsoft Teams; some in-office or community presence may be required based on business needs.
• Salary ranges vary by location, with specific figures provided for Zone 1 (Bay Area, Sacramento, LA, San Diego) and Zone 2 (Fresno, Bakersfield, Central Valley, Eastern California, Eureka).
• Benefits include medical, dental, vision, paid time off, holidays, retirement plans, wellness programs, and onsite EV charging stations.
• Our organization is committed to diversity and equal employment opportunity.
• Applicants must be authorized to work in the U.S. without sponsorship at this time.