Utilization Management RN - Hybrid Temporary

The Alliance; California, Northern (MO, KY); Hybrid; USD 108,000 - 120,000; Full time

Benefits offered by this job

Hybrid work environment

Job summary

The Alliance in Central California invites experienced RNs to join our temporary Utilization Management team. You will review prior authorization requests and perform concurrent or retrospective reviews of acute inpatient care using established criteria to ensure contractual compliance.

Ideal candidates hold a California RN license, have 5+ years in patient care with UM/Case Management exposure, and are proficient in Excel and PowerPoint. Hybrid work arrangements apply during the assignment.

Qualifications

• Bachelor’s degree in Nursing.
• Knowledge of managed care, the Medicare D-SNP and Medi-Cal programs.
• CMS guidelines including Local/National Coverage Determinations.
• Excel and PowerPoint proficiency; database software experience.
• Some knowledge of health care providers in the Alliance service area counties.

Responsibilities

• Ensures prior authorization reviews meet contractual requirements.
• Performs concurrent or post-service (retrospective) review of acute in-patient care using established criteria.
• Participates in the Utilization Management (UM) Care Programs.

Skills

Nursing

Utilization Management

Case Management

Microsoft Excel

PowerPoint

Database software

Education

Bachelor’s degree in Nursing

Tools

Excel

PowerPoint

Database software

Job description

The Alliance in Central California invites experienced RNs to join our temporary Utilization Management team. You will review prior authorization requests and perform concurrent or retrospective reviews of acute inpatient care using established criteria to ensure contractual compliance.

Ideal candidates hold a California RN license, have 5+ years in patient care with UM/Case Management exposure, and are proficient in Excel and PowerPoint. Hybrid work arrangements apply during the assignment.