About Our Company

At Altais, we’re looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.

About Your Team 

 Are you looking to work with a high performing, fast growing and dynamic Health & Innovation team? We are 4,000 physicians, working in over 40 cities throughout California, caring for more than 500,000 patients. If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you. 

About Your Work 

Join our Advanced Practice Medical Management team as a Utilization Management RN, where you’ll be at the forefront of ensuring patients receive timely access to vital medical treatments and services, and where your contributions make a difference every day. Your role will involve improving patient access and outcomes, making a real impact on patient care. 

As a Utilization Management RN, you'll work 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. 

In this role, you’ll be empowered to expand your skills and advance your career in healthcare and enhance the health and well-being of people through strengthened care experiences and health equality.

You will focus on 

• Interface with external agencies and representatives relative to the utilization management process, including health plans, medical providers, vendors and 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 and timely reports to members, providers and health plans as requested.
• Assist medical directors with benefit interpretation, obtain additional medical necessity information and research issues. Be available for case discussion as needed.
• Ability to use internet tools. Health plan websites and other sources of medical information to prepare cases for medical director review.

The Skills, Experience & Education You Bring

• Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to CMS, Title 22, NCQA (National Committee of Quality Assurance), DMHC (Department of Managed Health Care), and DHCS.
  • Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMA, all value-based reimbursement models, and alternative payment systems preferred.
• Prior MSO experience preferred.
• 2 years recent relevant experience.
• Recent MCG or InterQual experience highly desired.
• RN-Registered Nurse of California Licensure required.

You Share our Mission & Values 

• You are passionate about improving the healthcare experience and want to be part of the Altais mission. 
• You are bold and curious- willing to take risks, try new things and be creative. 
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard. 
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing. 
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency. 

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs. 

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, experience, and geographic location. This base pay range is specific to California and can vary based on Bay Area, Metro LA, and Greater California regions which may not be applicable to other locations.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us. 

Physical Requirements: 

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of workday. 

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.