Prior Authorizations Nurse LVN (Temporary)

Central California Alliance for Health; United States; Hybrid; USD 87,000 - 95,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

Paid time off

12 holidays per year

401(a) retirement plan

457 plan

Wellness program

EV charging

Job summary

Central California Alliance for Health is seeking a licensed vocational nurse for a full‑time temporary role in utilization management. You will review prior authorization requests and apply state regulations to ensure timely, evidence‑based care under the supervision of an RN.

Hybrid work is available; the assignment runs through 12/31/26 with potential extensions. Some in‑office presence may be required, and compensation aligns with Zone 1/2 pay scales for the California Central Valley region.

Qualifications

• Knowledge of MCG Care Guidelines in review determination process.
• Medi‑Cal and related policy and benefits‑related Title 22 regulations.
• Principles and practices of clinical nursing.

Responsibilities

• Ensure that prior authorization requests are completed in a timely fashion to meet contractual requirements and ensure reviews use evidence-based standards.

Skills

MCG Guidelines

Medi-Cal policy

Clinical nursing

Education

Licensed Vocational Nurse (CA)

High school diploma or equivalent

Job description

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member 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 of accessible, quality health care guided by local innovation leads everything 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 12/31/26, 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: Acts within the scope of the Board of Vocational Nursing and Psychiatric Technicians of the State of California to ensure that prior authorization requests are completed in a timely fashion to meet contractual requirements and ensure that all reviews are conducted using nationally recognized and evidence‑based standards.

WHAT YOU'LL NEED TO BE SUCCESSFUL

• Knowledge of:
  • MCG Care Guidelines in review determination process
  • Medi‑Cal and related policy and benefits‑related Title 22 regulations
  • Principles and practices of clinical nursing
• Ability to:
  • Evaluate medical records and other health care data
  • Interpret and apply policies and regulations
  • Define issues, conduct research, collect and review data, and contribute to the evaluation of options and individualized interventions related to the care plan or treatment plan, under the supervision of a professional Registered Nurse (RN)
• Education and Experience:
  • Current unrestricted license as a Licensed Vocational Nurse issued by the State of California
  • High school graduation or equivalent and a minimum of two years of experience performing work as a Licensed Vocational Nurse in a patient care setting which included some utilization management or case management responsibilities; or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities 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: $42 - $45.55
  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: $40 - $43
  Typical 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. You can reach out to [e-mail], and a member from our Talent Acquisition team will be in touch.

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

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 Central California Alliance for Health (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 Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.

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

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.