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Concurrent Review Nurse (RN)

Company: Central California Alliance For Health
Location: Scotts Valley
Posted on: January 16, 2022

Job Description:

We have an opportunity to join the Alliance as a Concurrent Review Nurse in the Utilization Management and Complex Case Management Department! Please note, there is one position to be filled and it can be filled in either our Scotts Valley, CA or Salinas, CA office. Interested candidates only need to submit one application.

What You'll Be Responsible For

Reporting to the Utilization Management Supervisor - Concurrent Review (RN), you will:

  • Perform concurrent or post-service (retrospective) review of acute in-patient care services using established criteria
  • Participate in the Utilization Management Care Programs
    • Working knowledge of Milliman Care Guidelines in review determination process
    • Some experience working in a managed care setting
      What You'll Need To Be Successful

      To read the full position description, and list of requirements click here
      • Knowledge of:
        • Knowledge of Utilization Management, and/or Case Management principles and practices;
        • Knowledge of Medi-Cal and related policies and Title 22 regulations
        • Ability to:
          • Ability to travel to Alliance-contracted acute, sub-acute, skilled-nursing and long-term care facilities to perform concurrent and/or retrospective review
          • Ability to demonstrate strong critical thinking and problem solving skills
          • Ability to 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
          • Ability to exercise good judgment and tact in relating to contracting health care providers and beneficiaries
          • Education and Experience:
            • Current unrestricted license as a Registered Nurse issued by the State of California
            • Associates degree in Nursing and a minimum of three years (or a Bachelors 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
              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
                COVID-19 Vaccine Requirement: This position requires staff to be fully vaccinated upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated is defined by the CDC. This means receipt of the second dose in a 2-dose series (Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (Johnson & Johnson) AND a 2-week period having passed since the administration of the last vaccine dose.

                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 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 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 Jobble

Keywords: Central California Alliance For Health, San Francisco , Concurrent Review Nurse (RN), Healthcare , Scotts Valley, California

Click here to apply!

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