Concurrent Review Nurse (RN)

We have an opportunity to join the Alliance as a Concurrent Review Nurse (RN) in the Utilization Management Department. 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Utilization Management Supervisor, this position: 

• Performs concurrent or post-service (retrospective) review of acute in-patient care services using established criteria
• Participates in the Utilization Management (UM) Care Program

ABOUT THE TEAM

Our mission is to optimize members’ healthcare outcomes through evidenced-based clinical management, stewardship, and collaboration with provider and community partners.

We determine medical necessity and benefit coverage for our members based on industry standards

WHAT YOU'LL NEED TO BE SUCCESSFUL

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

• 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
  • navigate and evaluate electronic medical records and other health care data in order to determine the appropriate level of care
  • give clear direction and sequence information verbally, so others can follow and understand
  • 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
  • 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

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation …