Utilization Management Nurse (RN) (Temporary)

We give priority to applicants who live in or near our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa.

About the role

This is a temporary, full-time (40 hours/week) position estimated to run from August to December 2026, dependent on business need. You will be employed by a temporary employment agency connected to the Alliance for the duration of the assignment. The role is hybrid, with remote interviews conducted via Microsoft Teams. While some work may be fully remote, attendance at quarterly company-wide events or department meetings is expected, and in-office or in-community presence may be required based on business need.

Responsibilities

• Ensure prior authorization requests are completed to meet contractual requirements, using nationally recognized and evidence-based standards.
• Perform concurrent or post-service (retrospective) review of acute in-patient care services using established criteria.
• Participate in Utilization Management (UM) Care Programs.

Requirements

• Current unrestricted license as a Registered Nurse issued by the State of California.
• Associate’s degree in Nursing and a minimum of five years of experience in a patient care setting, including at least one year in Utilization Management or Case Management. A Bachelor’s degree may substitute for two years of the required experience, or an equivalent combination of education and experience may be qualifying.

Qualifications

• Bachelor’s degree in Nursing (desirable).
• Working knowledge of managed care, Medicare D-SNP, Medi-Cal programs, and related regulations.
• Working knowledge of Centers for Medicare & Medicaid Services (CMS) guidelines, including applicable Local Coverage Determinations and National Coverage Determinations.
• Working knowledge of Microsoft Excel, PowerPoint, and database software.
• Some knowledge of health care providers in the Alliance service area counties.
• Knowledge of:
  • Utilization Management and/or Case Management principles and practices.
  • Principles and practices of clinical nursing.
  • MCG Guidelines in the review determination process.
  • Medi-Cal program, related regulations, and Title 22 regulations.
• Ability to:
  • Evaluate medical records and other health care data.
  • Interpret, apply, and explain policies, regulations, terms, and procedures.
  • Maintain organized and accurate records.

Pay

Compensation is based on work location and aligned to a zone according to the cost of labor in your area. Final pay will be determined by qualifications, experience, and other factors such as internal equity and market conditions.

• Zone 1 Pay Range: $52 - $57.50 per hour
  Typical areas: Santa Cruz, San Benito, Monterey Counties, Bay Area, Sacramento, Los Angeles, and San Diego.
• Zone 2 Pay Range: $49 - $54 per hour
  Typical areas: Mariposa, Merced Counties, Fresno, Bakersfield, Eastern California, San Luis Obispo, and the Central Valley (except Sacramento).

Benefits

Benefits listed below are available to regular Alliance employees working more than 30 hours per week and are not provided to temporary employees on assignment. Temporary employees will receive benefits through their staffing agency.

• Medical, Dental, and Vision Plans.
• Ample Paid Time Off and 12 Paid Holidays per year.
• 401(a) Retirement Plan and 457 Deferred Compensation Plan.
• Robust Health and Wellness Program.
• Onsite EV Charging Stations.

About Us

The Central California Alliance for Health (the Alliance) is a regional non-profit health plan serving members in Mariposa, Merced, Monterey, San Benito, and Santa Cruz counties. We are a team of over 500 employees committed to providing accessible, quality health care guided by local innovation. Our culture is respectful, diverse, professional, and fun, empowering employees to do their best work.