Job Opportunities API

OUR COMMITMENT TO A HUMAN HIRING PROCESS 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.   SERVICE AREA PREFERENCE 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.     ABOUT THIS TEMP POSITION This is a temporary position. The length of the assignment is estimated to go from August to December 2026, but this is always dependent on business need, and these dates may change. While the assignment would be at the Alliance, you would be an employee of a temporary employment agency that we would connect you with if hired for this position. This is a full-time (40 hours/week) temporary assignment. WHAT YOU'LL BE RESPONSIBLE FOR 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   Performs concurrent or post-service (retrospective) review of acute in-patient care services using established criteria    Participates in the Utilization Management (UM) Care Programs WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here .  Desirable Qualifications 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   Knowledge of: Utilization Management, and/or Case Management principles and practices Principles and practices of clinical nursing MCG  Guidelines in review determination process Medi-Cal  program  and related  regulations   and Title 22 regulations   Ability to: Evaluate medical records and other health care data Interpret, apply, and explain policies, regulations, terms, and procedures Maintain organized and accurate records 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  experie nce in Utilization Management or Case M anagement  (a  Bachelor’s  degree may substitute for two years of the required experience) ;   or an  equivalent  combination of education and experience may be qualifying   OTHER INFORMATION We are in a hybrid work enviro