Temporary Concurrent Review Nurse - Central California Alliance for Health (Remote)
Santa Cruz, CA
About the Job
ABOUT THIS TEMP POSITION
This is a temporary position. 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.
WHAT YOU'LL BE RESPONSIBLE FOR
Perform concurrent or post-service (retrospective) review of acute in-patient care services using established criteria. You will also:
- Perform preauthorization, concurrent and post-service review for all Alliance members in acute, sub-acute, skilled nursing and long term care facilities, using established criteria/protocols as approved by the plan
- Participate in the Utilization Management (UM) Care Programs
- Coordinate transition planning for members from acute hospitalization and/or skilled nursing facility placement
WHAT YOU'LL NEED TO BE SUCCESSFUL
- Knowledge of:
- Utilization Management, and/or Case Management principles and practices
- Medi-Cal and related policies and Title 22 regulations
- Ability to:
- demonstrate strong critical thinking and problem solving skills
- use of MS Office Software Suite
- navigate and evaluate electronic medical records and other health care data in order to determine the appropriate level of care
- Ability to give clear direction and sequence information verbally, so others can follow and understand
- Education and Experience:
- Associate's degree in Nursing and a minimum of three years (or a Bachelor's degree and one year) of experience in an acute care setting, which included some experience in Utilization Management, Case Management or similar health programs; or an equivalent combination of education and relevant work experience may be qualifying
- Current unrestricted license as a Registered Nurse issued by the State of California
To read the full position description, and list of requirements click here
OTHER DETAILS
- While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
- Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
- Based on the nature of work, this position may require onsite presence, which 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)
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
OUR BENEFITS
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 12 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Onsite EV Charging Stations
- And many more
ABOUT US
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.
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
Join us at Central California Alliance for Health (the Alliance) 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 currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.
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.
