Remote RN: Prior Authorization & Utilization Management

Central California Alliance for Health (Remote); San Francisco (CA); Remote; USD 72,000 - 79,000; Part time

Job summary

Central California Alliance for Health is seeking a Part Time Prior Authorizations Nurse (RN) for a temporary assignment based remotely in California. The role reports to the Utilization Management Supervisor and supports the UM Care Programs.

The position offers 20–40 hours per week, Monday–Friday, with no guaranteed benefits for temporary staff. The ideal candidate will hold a CA RN license and have knowledge of managed care, CMS guidelines, and experience in utilization management.

Qualifications

• Bachelor’s degree in Nursing or higher and valid CA RN license.
• Working knowledge of managed care, Medicare D-SNP and Medi-Cal programs.
• Familiarity with CMS guidelines and Local/ National Coverage Determinations.
• Proficient in Excel and PowerPoint; database software familiarity.

Responsibilities

• Ensure that prior authorization requests meet contractual requirements using evidence-based standards.
• Participate in the Utilization Management Care Programs.

Skills

RN License

Utilization Management

CMS guidelines

Excel

PowerPoint

Education

Bachelor’s degree in Nursing

Associate degree in Nursing

Tools

Microsoft Excel

PowerPoint

Job description

Central California Alliance for Health is seeking a Part Time Prior Authorizations Nurse (RN) for a temporary assignment based remotely in California. The role reports to the Utilization Management Supervisor and supports the UM Care Programs.

The position offers 20–40 hours per week, Monday–Friday, with no guaranteed benefits for temporary staff. The ideal candidate will hold a CA RN license and have knowledge of managed care, CMS guidelines, and experience in utilization management.