Remote Prior Authorization RN – Utilization Management

Central California Alliance for Health (Remote); California; Hybrid; USD 52,000 - 58,000; Full time

Benefits offered by this job

Remote in California

Job summary

Central California Alliance for Health is seeking a Prior Authorizations Nurse (RN) for a temporary, full-time role. This remote-in-California position reports to the Utilization Management Supervisor and involves ensuring PA requests comply with contracts and evidence-based standards.

Requirements include a CA RN license, 5+ years in nursing with UM/Case Management experience, and proficiency in Excel/PowerPoint. Some knowledge of CMS guidelines and Medi-Cal is preferred.

Qualifications

• Desirable Qualifications: Bachelor’s degree in Nursing
• Knowledge of managed care and related regulations is preferred
• CMS guidelines familiarity is preferred
• Working knowledge of Excel and PowerPoint

Responsibilities

• Ensure prior authorization requests meet contractual requirements and are reviewed using evidence-based standards
• Participate in Utilization Management Care Programs

Skills

Nursing knowledge

Records evaluation

Policy interpretation

Education

Bachelor’s degree in Nursing

Associate’s degree in Nursing

Tools

Excel

PowerPoint

Job description

Central California Alliance for Health is seeking a Prior Authorizations Nurse (RN) for a temporary, full-time role. This remote-in-California position reports to the Utilization Management Supervisor and involves ensuring PA requests comply with contracts and evidence-based standards.

Requirements include a CA RN license, 5+ years in nursing with UM/Case Management experience, and proficiency in Excel/PowerPoint. Some knowledge of CMS guidelines and Medi-Cal is preferred.