Prior Authorizations Nurse RN Specialist

4 weeks ago


Santa Cruz, California, United States Central California Alliance for Health Full time
Prior Authorizations Nurse RN Job Description

We are seeking a skilled Prior Authorizations Nurse RN to join our team at Central California Alliance for Health. As a Prior Authorizations Nurse RN, you will play a critical role in 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.

Key Responsibilities:

• Ensure timely completion of prior authorization requests to meet contractual requirements
• Conduct reviews using nationally recognized and evidence-based standards
• Collaborate with healthcare providers to obtain necessary information for reviews
• Develop and maintain knowledge of Milliman Care Guidelines, Medi-Cal and related policy, and Title 22 regulations

Requirements:

• Bachelor's degree in Nursing and a minimum of three years of experience in a patient care setting
• Minimum of one year of experience in Utilization Management or Case Management
• Current unrestricted license as a Registered Nurse issued by the State of California

What We Offer:

• Competitive compensation package
• Ample paid time off and 12 paid holidays per year
• 401(a) Retirement Plan and 457 Deferred Compensation Plan
• Robust Health and Wellness Program and onsite EV charging stations

About Us:

We are a regional non-profit health plan serving members in Mariposa, Merced, Monterey, San Benito, and Santa Cruz counties. We are committed to providing accessible, quality healthcare that is guided by local innovation. If you are a motivated and detail-oriented Prior Authorizations Nurse RN looking for a challenging and rewarding role, please apply today.

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