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Prior Authorizations Nurse, RN – Temporary
Central California Alliance for Health. Complete prior authorization requests in a manner meeting contractual requirements .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Prior Authorization principles and practices, Utilization Management, and clinical nursing principles. Proficient in evaluating medical records and applying relevant regulations, with strong organizational skills for maintaining accurate records.
Highest-signal resume keywords
Registered Nurse License - CaliforniaUtilization Management ExperiencePrior Authorization KnowledgeMCG Guidelines FamiliarityClinical Nursing Principles
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Prior AuthorizationUtilization ManagementClinical NursingMedical Record EvaluationPolicy InterpretationRegulation ApplicationOrganizational SkillsMedi-Cal KnowledgeCMS GuidelinesCase Management
Soft Skills
CommunicationAttention to DetailProblem-Solving
Tools & Technologies
Microsoft ExcelMicrosoft PowerPointDatabase Software
Certifications & Qualifications
Registered Nurse License
Industry Keywords
Medi-Cal ProgramManaged CareMedicare D-SNPTitle 22 RegulationsLocal Coverage DeterminationsNational Coverage Determinations
About the role
Key responsibilities & impact- Complete prior authorization requests in a manner meeting contractual requirements
- Conduct prior authorization reviews using nationally recognized, evidence-based standards
- Participate in Utilization Management (UM) Care Programs
- Report to the Utilization Management Supervisor
Requirements
What you’ll need- Current unrestricted license as a Registered Nurse issued by the State of California
- Associate’s degree in Nursing
- Minimum of five years of experience in a patient care setting
- Minimum of one year of experience in Utilization Management or Case Management
- A Bachelor’s degree may substitute for two years of the required experience
- An equivalent combination of education and experience may be qualifying
- Knowledge of Prior Authorization principles and practices
- Knowledge of clinical nursing principles and practices
- Knowledge of MCG Guidelines in the review determination process
- Knowledge of Medi-Cal program, related regulations, and Title 22 regulations
- Ability to evaluate medical records and other health care data
- Ability to interpret, apply, and explain policies, regulations, terms, and procedures
- Ability to maintain organized and accurate records
- Working knowledge of managed care, Medicare D-SNP, Medi-Cal programs, and related regulations
- Working knowledge of CMS guidelines, including Local Coverage Determinations and National Coverage Determinations
- Working knowledge of Microsoft Excel, PowerPoint, and database software
- Must be currently authorized to work in the United States on a full-time, ongoing basis without current or future employer sponsorship
- Bachelor’s degree in Nursing, knowledge of Alliance service-area health care providers, and related software knowledge are listed as desirable qualifications
Benefits
Comp & perks- Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options
- Medical, Dental and Vision Plans (listed as standard language, not provided for this temporary position)
- Ample Paid Time Off (listed as standard language, not provided for this temporary position)
- 12 Paid Holidays per year (listed as standard language, not provided for this temporary position)
- 401(a) Retirement Plan (listed as standard language, not provided for this temporary position)
- 457 Deferred Compensation Plan (listed as standard language, not provided for this temporary position)
- Robust Health and Wellness Program (listed as standard language, not provided for this temporary position)
- Onsite EV Charging Stations (listed as standard language, not provided for this temporary position)