Prior Authorizations Nurse (RN) (Temporary)

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. 

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. 

This is a temporary position, and the length of the assignment is estimated to go through the end of 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.

Reporting to the Utilization Management Supervisor, this position: 

• 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

• Bachelor’s degree in Nursing
• Working knowledge of managed care, the Medicare D-SNP and Medi-Cal programs, and related regulations
• Working knowledge of Centers for Medicare & Medicaid Services (CMS) guidelines, including applicable Local Coverage Determinations and National Coverage Determinations · Working knowledge of Microsoft Excel and PowerPoint, and database software
• Some knowledge of health care providers in the Alliance service area counties

To read the full position description and list of requirements, click here. 

• Knowledge of:
  • MCG Guidelines in review determination process
  • Principles and practices of clinical nursing
  • Medi-Cal program and related regulations and Title 22 regulations, Centers for Medicare & Medicaid Services (CMS) guidelines including applicable Local Coverage Determinations and National Coverage Determination
• Ability to:
  • Evaluate medical records and other health care data
  • prepare narrative and statistical reports, correspondence, and other program documents
  • Quickly learn and gain expertise in a broad variety of medical records systems
• Education and Experience:
  • Current unrestricted license as a Registered Nurse issued by the State of California
  • Associate’s degree in Nursing and a minimum of five years of experience in a patient care setting which included a minimum of one year of experience in Utilization Management or Case Management
  • Experience, or an equivalent combination of education and experience, which would provide the required knowledge, skills and abilities may be qualifying

• We anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
• This is a temporary position and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options.  

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. 

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.