Utilization Management Supervisor - Prior Authorizations (Rn)

Central California Alliance For Health Merced , CA 95343

Posted 2 months ago

Please note: There is one position available and it can be filled in either our Scotts Valley or Merced office. 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 Central California Alliance for Health (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 330,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here or check out this video.

WHAT YOU'LL BE RESPONSIBLE FOR

You will be responsible for supervising, mentoring and training assigned staff as well as supervising Prior Authorizations operations activities. You will also assist the Utilization Management senior leadership team with department oversight activities and fill in for Prior Authorizations Nurse staff, as needed.

ABOUT THE TEAM

Prior Authorization (PA) is the process by which physicians and other health care providers must obtain approval from a health plan for a specific procedure, service, device, supply or medication to be delivered to the patient to qualify for payment coverage. The ultimate purpose of the PA function at the Alliance is to optimize patient outcomes by ensuring that our members receive the most appropriate care available. Our PA team reviews provider requests using nationally recognized and evidence-based standards and ensures that these reviews are completed in a timely fashion to meet contractual requirements and promote the quick delivery of high quality care. Our team is comprised of RN's and LVN's who appreciate and respect one another and are always willing to share knowledge to promote learning and growth. We are a high-functioning team that recognizes and draws upon the strengths of each person in order to best serve Alliance members and providers. The work is high volume, fast-paced and we love what we do.

THE IDEAL CANDIDATE

  • Demonstrated experience leading a team and supporting the professional growth of staff

  • Ability to identify opportunities for process improvement and act on solutions

  • Bachelor's degree in Nursing

  • Experience working in a managed care or hospital setting

  • Experience related to prior authorizations or case management

  • Some knowledge of Knox-Keene, Medi-Cal, Title 22 and/or related regulations

WHAT YOU'LL NEED TO BE SUCCESSFUL

  • Knowledge of:

  • Principles, practices, tools and techniques used in clinical nursing

  • Principles and practices of supervision and training

  • Working knowledge of the principles and practices of utilization management

  • Working knowledge of the methods and techniques of research, analysis and reporting

  • Ability to:

  • Supervise, train and evaluate the work of staff

  • Organize and prioritize the work of others, delegate work effectively, and follow up on work assignments

  • Motivate staff and promote an atmosphere of teamwork and cooperation

  • Provide leadership and facilitate meetings

  • Evaluate medical records and other health care data

  • Education and Experience:

  • Current unrestricted license as a Registered Nurse issued by the State of California

  • Associate's degree in Nursing

  • 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

To read the full position description, and list of requirements click here 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

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 sponsorship.


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Utilization Management Supervisor - Prior Authorizations (Rn)

Central California Alliance For Health