Prior Authorizations Nurse (RN) (Temporary)

ccah · Remote in California · Remote

<div class="content-intro"><a href="https://thealliance.health/about-the-alliance/careers/" target="_blank"><img style="max-width: 100%;" src="https://thealliance.health/wp-content/uploads/Greenhouse-Board-Banner-Graphic.jpg" width="1200"></a> OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is reviewed by a 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. </div>  <hr> <h4>ABOUT THIS TEMP POSITION</h4> 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. <h4>WHAT YOU'LL BE RESPONSIBLE FOR</h4> Reporting to the Utilization Management Supervisor, this position:  <ul> <li>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 </li> <li data-leveltext="%1." data-font="Calibri Light" data-listid="14" data-list-defn-props="{"335552541":0,"335559685":360,"335559991":360,"469769242":[65533,0],"469777803":"left","469777804":"%1.","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Participates in the Utilization Management (UM) Care Programs</li> </ul> <h4>WHAT YOU'LL NEED TO BE SUCCESSFUL</h4> To read the full position description and list of requirements, <a href="https://thealliance.health/wp-content/uploads/Prior_Authorizations_Nurse_RN-1.pdf" target="_blank">click here</a>.  <ul> <li>Desirable Qualifications <ul> <li>Bachelor’s degree in Nursing </li> <li>Working knowledge of managed care, the Medicare D-SNP and Medi-Cal programs, and related regulations </li> <li>Working knowledge of Centers for Medicare & Medicaid Services (CMS) guidelines, including applicable Local Coverage Determinations and National Coverage Determinations </li> <li>Working knowledge of Microsoft

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