Utilization Management Nurse, RN

About Altais: At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system. About the Role Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. As a Utilization Management RN,you'llwork closely with our Ambulatory and Concurrent Care, Network Management, Quality Improvement, and Practice Success teams.Your responsibilities include driving efficient authorization processes, navigating insurance requirements with precision and advocacy.We seek individuals with a strong commitment to patient-centered care and a passion for promoting health and wellness. You will focus on: Interface with external agencies and representativesrelativeto theutilizationmanagement process, including health plans, medical providers,vendorsand CMS. Perform Utilization Review activities prospectively or post-service (retrospective) for elective/urgent hospital admissions and outpatient services as specified on the Prior Authorization List with complete andtimelyreports to members, providers and health plans as requested. Assistmedical directors with benefit interpretation, obtainadditionalmedical necessity information and research issues. Be available for case discussion as needed. Works closely with physicians, othe