1 other jobs found in Monterey, CA

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...