Remote Utilization Management Nurse (RN)

Central California Alliance for Health; San Jose (CA); Hybrid; USD 72,000 - 80,000; Full time

Benefits offered by this job

Hybrid work environment

Job summary

Central California Alliance for Health in California is seeking a Registered Nurse for a temporary Utilization Management role. You will ensure prior authorizations comply with contracts and participate in UM care programs.

Required are an active CA RN license and at least five years in patient care with UM/Case Management exposure; some education paths may substitute for experience. Hybrid work and remote- interview options are offered.

Qualifications

• Current unrestricted license as a Registered Nurse issued by the State of California.
• Associate’s degree in Nursing with minimum experience requirements; bachelor’s degree may substitute for two years of experience.

Responsibilities

• Ensures that prior authorization requests meet contractual requirements and reviews use evidence-based standards.
• Performs concurrent or retrospective review of acute in-patient care services using established criteria.
• Participates in the Utilization Management (UM) Care Programs.

Skills

Evaluate medical records

Interpret policies

Maintain organized records

Utilization Management

Case Management

Clinical nursing

CMS guidelines

Excel

PowerPoint

Education

Registered Nurse license ( California )

Associate’s degree in Nursing

Bachelor’s degree may substitute for two years of experience

Tools

Microsoft Excel

PowerPoint

Database software

Job description

Central California Alliance for Health in California is seeking a Registered Nurse for a temporary Utilization Management role. You will ensure prior authorizations comply with contracts and participate in UM care programs.

Required are an active CA RN license and at least five years in patient care with UM/Case Management exposure; some education paths may substitute for experience. Hybrid work and remote- interview options are offered.