Prior Authorizations Nurse I - RN, Scotts Valley, CA
Prior Authorizations Nurse I - RN
at Central California Alliance for Health
Scotts Valley, CA
There are two positions available.
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 350,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here or check out this video.
WHAT YOU'LL BE RESPONSIBLE FOR
Ensuring that prior authorization requests are completed in a timely fashion to meet contractual requirements and that all reviews are conducted using nationally recognized and evidence based standards.
WHAT YOU'LL NEED TO BE SUCCESSFUL
- Milliman Care Guidelines in review determination process
- Medi-Cal and related policy and Title 22 regulations
- Utilization management principles and activities
- Case management principles and activities
- Understand concepts pertaining to prepaid health care
- Demonstrate strong critical thinking and clinical nursing skills
- Evaluate medical records and other health care data
- Exercise good judgment and professional consideration with health care providers and beneficiaries
Education and Experience:
- Current unrestricted California Registered Nurse license
- Minimum three years of experience in a patient care setting
- Minimum one year of experience in Utilization Management, case management; or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying
To read the full position description, and list of requirements click here.
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 11 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Fresh Fruit Delivery
- EV Charging Stations
- And many more
Applicants must be currently authorized to work in the United States on a full-time basis.