Central California Alliance for Health is hiring a
Temporary Concurrent Review Nurse

Summary

Join us at Central California Alliance for Health (the Alliance) as a temporary position to perform concurrent or post-service review of acute in-patient care services, utilizing established criteria. You will also participate in the Utilization Management (UM) Care Programs and coordinate transition planning for members from acute hospitalization and/or skilled nursing facility placement.

Requirements

• Knowledge of: Utilization Management, and/or Case Management principles and practices
• Knowledge of: Medi-Cal and related policies and Title 22 regulations
• Ability to: demonstrate strong critical thinking and problem solving skills
• Ability to: use of MS Office Software Suite
• 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
• 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
• Current unrestricted license as a Registered Nurse issued by the State of California

Responsibilities

• Perform concurrent or post-service (retrospective) review of acute in-patient care services using established criteria
• Perform preauthorization, concurrent and post-service review for all Alliance members in acute, sub-acute, skilled nursing and long term care facilities, using established criteria/protocols as approved by the plan
• Participate in the Utilization Management (UM) Care Programs
• Coordinate transition planning for members from acute hospitalization and/or skilled nursing facility placement