Remote Utilization Nurse (RN) - Prior Authorization

Central California Alliance for Health; California (MO); Hybrid; USD 108,000 - 120,000; Full time

Job summary

Central California Alliance for Health is seeking a Prior Authorizations Nurse (RN) for a temporary, full-time role remote in California. The position covers reviews to ensure authorizations meet standards, with prospective, concurrent, and retrospective components and UM program participation.

Ideal candidates hold a California RN license, a nursing degree, and knowledge of CMS/Medi-Cal guidelines, with strong data handling skills and healthcare regulation familiarity.

Qualifications

• Bachelor’s degree in Nursing and active California RN license.
• Knowledge of Utilization Management, Case Management and CMS guidelines.
• Experience with Excel, PowerPoint and database software.
• Understanding of Medi-Cal/Medicare programs and relevant regulations.

Responsibilities

• Ensure prior authorization requests meet contractual requirements and standards.
• Perform concurrent or retrospective reviews of acute in-patient care.
• Participate in Utilization Management Care Programs.

Skills

Utilization Management

Case Management

Nursing Knowledge

CMS guidelines

Education

Bachelor’s degree in Nursing

RN license California

Associate’s degree in Nursing

Tools

Excel

PowerPoint

Database software

Job description

Central California Alliance for Health is seeking a Prior Authorizations Nurse (RN) for a temporary, full-time role remote in California. The position covers reviews to ensure authorizations meet standards, with prospective, concurrent, and retrospective components and UM program participation.

Ideal candidates hold a California RN license, a nursing degree, and knowledge of CMS/Medi-Cal guidelines, with strong data handling skills and healthcare regulation familiarity.