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WHAT YOU'LL BE RESPONSIBLE FOR:
- Ensuring prior authorization requests meet contractual requirements using evidence-based standards.
- Participating in the Utilization Management (UM) Care Programs.
- Evaluating medical records and health care data to apply policies and regulations.
WHAT YOU'LL NEED TO BE SUCCESSFUL:
- Current unrestricted RN license in California and a Bachelor's degree in Nursing.
- Working knowledge of managed care, Medi-Cal, CMS guidelines, and prior authorization principles.
- Proficiency in Microsoft Excel, PowerPoint, and database software.
COMPENSATION:
- Zone 1 pay range: $52 - $57.50 per hour; Zone 2: $49 - $54 per hour.
- Final compensation based on qualifications and geographic location.
- This is a temporary position; benefits not provided.
Central California Alliance for Health
Central California Alliance for Health is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. 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.