There is one (1) position available and it can be filled in Scotts Valley or Merced.
ABOUT US: The Alliance is an award-winning regional not-for-profit health plan. We currently serve over 350,000 members in Santa Cruz, Monterey and Merced counties. We are a group of dedicated individuals driven by our mission of providing accessible, quality health care that is guided by local innovation. We are value-based, guided by the following:
• Culture: We strive for a respectful, diverse, professional and fun workplace. • Customer Service: Our customers’ satisfaction is our highest priority. • Excellence: We value and continuously improve quality in our services. • Innovation: We leverage local talent to create solutions. • Integrity: We tell the truth and do what we say we will do. • Partnership: We collaborate with others for strong solutions. • Stewardship: We manage responsibly, and earn the trust of partners and regulators.
ABOUT THE TEAM: The Prior Authorizations team falls under the Utilization Management department at the Alliance. We are a team of about 20 individuals, comprised of RN’s and LVN’s who appreciate one another and are always willing to share knowledge. We are a high-functioning team that recognizes and draws upon the strengths of each person in order to best serve our members and providers. Our work is high volume, fast-paced and we love what we do.
ABOUT YOU: You have strong people management skills with the ability to coach and mentor your team through change, and you champion process improvement. You are able to assess workflows, identify areas for improvement and make strategic recommendations. Taking a diplomatic approach to your work, you are a fair-minded and communicative leader who strives for effective and positive outcomes. The ideal candidate has experience working in managed care or other health plan environments.
RESPONSIBILITIES: Under direction, this position plans, organizes and manages the Prior Authorizations and Health Services Authorizations units, manages, supervises, mentors and trains assigned staff, and provides leadership in Health Services programs, operations, projects, policies and procedures to ensure high quality results.
YOU WILL BRING: • Thorough knowledge of the principles, practices, tools and techniques used in clinical nursing • Working knowledge of the principles and practices of: - Utilization management - Supervision and training • Some knowledge and understanding of the concepts pertaining to managed health care • Some knowledge of Knox Keene, Medi-Cal, Title 22 and related regulations • Ability to: - Evaluate medical records and other health care data - Plan, develop, manage, coordinate, improve, implement and evaluate programs, projects, systems, activities and work plans - Develop and implement revisions to standard operating procedures to improve effectiveness or comply with regulatory changes - Supervise, train and evaluate the work of staff - Organize and prioritize the work of others, delegate authority and responsibility, and follow up on work assignments - Motivate staff and promote an atmosphere of teamwork and cooperation - Interpret, explain and apply applicable regulations - Exercise good judgment and tact in relating to contracted health care providers and beneficiaries - Quickly learn and use Alliance databases and systems, including the claims and authorization management software - Identify issues, conduct research, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action - Prepare written and oral reports • Education and Experience: - California license as a Registered Nurse, Bachelor’s degree in Nursing or an Associate’s degree in Nursing and a Bachelor’s degree in a closely related field - A minimum of five (5) years of clinical nursing experience, which included one year of utilization management experience, and a minimum of three years of supervisory experience; or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying
BENEFITS: • Medical, Dental and Vision Plans • Generous Paid Time Off • 11 Paid Holidays per Year • 401(a) Retirement Plan • 457 Deferred Compensation Plan • Tuition Reimbursement • Costco Membership Reimbursement • Health and Wellness Program • Fresh Fruit Delivery • Electric Vehicle Charging Stations • And many more! (https://ccah-alliance.silkroad.com/map_images/main/SiteGen/ccahext/Content/Uploads/Unplaced_Documents/Benefits_Summary.pdf)
?For a complete position description and to apply online, please visit our careers website at https://ccah-alliance.silkroad.com
If this sounds like an opportunity that you or someone you know may be interested in we invite you to apply! Applicants must be currently authorized to work in the United States on a full-time basis.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status.