Utilization Management Supervisor- Prior Authorizations RN

Profile

We have an opportunity to join the Alliance as a Utilization Management Supervisor - Prior Authorizations (RN)
WHAT YOU'LL BE RESPONSIBLE FOR
You will supervise, mentor and train assigned staff and supervise Prior Authorizations (PA) operational activities; Perform all of the duties of a PA Nurse; Assist Utilization Management (UM) Manager-PA and UM Director with department oversight activities
ABOUT THE TEAM
​We determine medical necessity and benefit coverage for our members based on industry standards.
W
HAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here
Knowledge of:
The principles, practices, tools and techniques used in clinical nursing
The principles and practices of utilization management
The methods and techniques of research, analysis and reporting
Ability to:
Evaluate medical records and other health care data
Supervise, train and evaluate the work of staff
Organize and prioritize the work of others, delegate work effectively, and follow up on work assignments
Plan, organize and prioritize tasks and work schedules, manage projects and adhere to timelines
Motivate staff and promote an atmosphere of teamwork and cooperation
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 three to five years of clinical nursing experience which included some utilization management experience and some supervisory or team lead experience; or a combination of education and relevant work experience may be qualifying
OTHER DETAILS
While this position is connected to one of our Alliance offices, we are in a fully telecommute work environment right now due to the COVID-19 pandemic. The interview and on-boarding process for this position will be completed remotely
This position
may
require onsite presence when our offices re-open, which will be no sooner than February 1, 2022. Onsite presence will most likely be on a part-time basis, but is dependent on business needs
Additionally, all positions at the Alliance are required to meet these minimum qualifications
OUR BENEFITS
Medical, Dental and Vision Plans
Ample Paid Time Off
11 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
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.
Join us at **MEMBERS ONLY**SIGN UP NOW***. (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 over 377,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here
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.

Company info

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