$77,654 - $136,240 yearly
Central California Alliance for Health
Hybrid (Scotts Valley, CA, USA)
We have an opportunity to join the Alliance as a Prior Authorization Nurse (RN) in the Utilization Management Department in either our Merced, Salinas or Scotts Valley, California office.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Prior Authorizations Supervisor (RN), you will:
Ensure that prior authorizations requests are completed in a timely fashion to meet contractual requirements and that all reviews are conducted using nationally recognized evidence based standards
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here .
Knowledge of:
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
Ability to:
Understand concepts pertaining to prepaid health care
Demonstrate strong critical thinking and clinical nursing skills...
