Nurse Specialist in Prior Authorization
2 weeks ago
We are excited to present an opportunity to join the Central California Alliance for Health as a Nurse Specialist in Prior Authorization within our Utilization Management team. This role can be performed from any of our designated offices.
KEY RESPONSIBILITIES
Under the guidance of the Utilization Management Supervisor, you will be tasked with ensuring that prior authorization requests are processed efficiently to comply with contractual obligations, while adhering to nationally recognized and evidence-based standards.
TEAM OVERVIEW
Our team is dedicated to assessing medical necessity and benefit coverage for our members, utilizing industry standards to guide our decisions.
ESSENTIAL QUALIFICATIONS
For a comprehensive overview of the position and its requirements, please refer to the detailed job description.
- Required Knowledge:
- Familiarity with Milliman Care Guidelines in the review determination process
- Understanding of Medi-Cal policies and Title 22 regulations
- Principles and practices of utilization management
- Case management methodologies
- Required Skills:
- Ability to grasp concepts related to prepaid healthcare
- Demonstrated critical thinking and clinical nursing capabilities
- Competence in evaluating medical records and healthcare data
- Education and Experience:
- Active, unrestricted Registered Nurse license issued by the State of California
- Bachelor's degree in Nursing along with a minimum of three years of experience in a clinical setting, including at least one year in Utilization Management or Case Management; or an equivalent combination of education and experience
- This position operates in a hybrid work environment, with interviews conducted remotely.
- Some employees may have the option to work fully remotely, but attendance at quarterly company-wide events or departmental meetings is expected.
- In-office or community presence may be necessary for certain roles, depending on business needs, and will be discussed during the interview.
The compensation range for this position varies by location and is determined based on our compensation philosophy, the selected candidate's qualifications, and other relevant factors.
Compensation Range:
$80,189.46 - $141,003.20 USD
BENEFITS
Our benefits package is available to all regular employees working over 30 hours per week, with some benefits available on a pro-rated basis for part-time employees.
- Medical, Dental, and Vision Plans
- Generous Paid Time Off
- 12 Paid Holidays annually
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Comprehensive Health and Wellness Program
- Onsite EV Charging Stations
At Central California Alliance for Health, we are a team of over 500 dedicated professionals committed to our mission of providing accessible, quality healthcare driven by local innovation. We believe our work has a significant impact on the communities we serve.
Join us in a culture that values respect, diversity, professionalism, and enjoyment, where you are empowered to excel in your role. As a regional non-profit health plan, we serve members across multiple counties.
The Alliance is an equal opportunity employer, and we welcome qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, veteran status, or disability status. We participate in E-Verify and do not provide sponsorship for employment.
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