Concurrent Review Nurse (RN)

We have an opportunity as a Concurrent Review Nurse (RN), part of the Utilization Management and Complex Case Management Department. WHAT YOU'LL BE RESPONSIBLE FOR Under limited supervision, this position performs concurrent or post-service (retrospective) reviews of acute in-patient care services using established criteria; Participates in the Utilization Management (UM) Care Programs. ABOUT THE TEAM We review member care and services to validate the necessity and to explore alternatives to inpatient care. We also track the consumption of resources and the progress of members while being treated. 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 * Travel to Alliance-contracted acute, sub-acute, skilled-nursing and long-term care facilities to perform concurrent and/or retrospective reviews * Use MS Office Software Suite * 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 DETAILS While this position is connected to our Merced office, we are in a fully remote work environment right now due to COVID-19. The interview and on-boarding process will be completed remotely. When our offices re-open, this role will have to travel to facilities. 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 330,000 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 sponsorship.

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