Alignment Health
501 - 1000 employees
Founded 2013
⚕️ Healthcare Insurance
💰 $135M Series C on 2020-03
Healthcare Insurance • Insurance • Healthcare
Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.
Lead Utilization Management Nurse, California LVN/RN License
🕒 May 26
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Alignment Health
501 - 1000 employees
Founded 2013
⚕️ Healthcare Insurance
💰 $135M Series C on 2020-03
Healthcare Insurance • Insurance • Healthcare
Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.
📋 Description
• Reviewing requests for inpatient and prior authorization services for all plan members. • Works in collaboration with UM leaders and providers to ensure timely processing of referrals. • Oversees supports the team of UM Nurses with clinical decision-making tasks. • Participates in department quality audits and vendor audits to assess timeliness of cases. • Collaborates with other leaders in the department to develop and improve processes and workflows. • Leads, initiates and follows through on multiple projects simultaneously in a team environment.
🎯 Requirements
• Minimum of (3) consecutive years of related experience in concurrent review and/or prior authorization at managed care organization. • Minimum (2) years of experience using MCG • Knowledge of Medicare Managed Care Manuals and CMS regulatory requirements. • Effective written and oral communication skills • Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact)
🏖️ Benefits
• Competitive salary • Health insurance • Professional development opportunities • Paid time off
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