Prior Authorizations Nurse; RN); Temporary

Remote in California

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration.

That’swhy we do not use AI or automated systems toreview applications . Every application is reviewed bya real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in , or near, our service counties:
Santa Cruz, Monterey, Merced, San Benito, and Mariposa . Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

This is a temporary position. The length of the assignment is estimated to go from August to the end of December 2026, but this is always dependent on business need, and these dates may change. While the assignment would be at the Alliance, you would be an employee of a temporary employment agency that we would connect you with if hired for this position.

This is a full-time (40 hours/week) temporary assignment.

Reporting to the Utilization Management Supervisor, this position:

• Ensures that prior authorization requests are completed in a manner that meets contractual requirements and that all prior authorization reviews are conducted using nationally recognized and evidence-based standards
• Participates in the Utilization Management (UM) Care Programs

• Desirable Qualifications
  • Bachelor’s degree in Nursing
  • Working knowledge of managed care, the Medicare D-SNP and Medi-Cal programs, and related regulations
  • Working knowledge of Centers for Medicare & Medicaid Services (CMS) guidelines, including applicable Local Coverage Determinations and National Coverage Determinations
  • Working knowledge of Microsoft Excel and PowerPoint, and database software
  • Some knowledge of health care providers in the Alliance service area counties
• Knowledge of:
  • Prior Authorization principles and practices
  • Principles and practices of clinical nursing
  • MCG Guidelines in review determination process
  • Medi-Cal program and related regulations and Title 22 regulations
• Ability to:
  • Evaluate medical records and other health care data
  • Interpret, apply, and explain policies, regulations, terms, and procedures
  • Maintain organized and accurate records
• Education and Experience:
  • Current unrestricted license as a Registered Nurse issued by the State of California
  • Associate’s degree in Nursing and a minimum of five years of experience in a patient care setting which included a minimum of one year of experie nce in Utilization Management or Case M anagement (a Bachelor’s degree may substitute for two years of the required experience) ; or an equivalent combination of education and experience may be qualifying

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
• This is a temporary position and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed). Temporary…