Remote Utilization Management Nurse Coordinator (RN/LVN)

Yoh Services LLC; Redding (CA); Remote; USD 62,000 - 76,000; Full time

Benefits offered by this job

Remote work

Direct deposit

Competitive pay

Benefits eligibility

Job summary

Yoh is seeking a Utilization Management Nurse Coordinator (RN or LVN) for a 6+ month remote contract with a managed care client based in Northern California. Training occurs onsite in Fairfield or Redding for three weeks, then transitions to fully remote.

The role reviews outpatient authorizations, assesses medical necessity, and collaborates with interdisciplinary teams to ensure appropriate care while complying with CMS and health plan guidelines.

Qualifications

• Active/unrestricted CA RN or LVN license required.
• Experience in Utilization Management, Prior Authorization, Case Management or Managed Care.
• Strong knowledge of CMS/Medicare/Medicaid guidelines.
• Ability to work independently with initiative and flexibility.
• Solid critical thinking and problem-solving skills.
• Comfortable in a fast-paced, member-service oriented setting.

Responsibilities

• Review outpatient authorization requests using InterQual and guidelines.
• Evaluate medical necessity and coverage requirements.
• Analyze clinical documentation from providers and facilities.
• Approve services within RN authority and escalate complex cases.
• Communicate with providers to obtain additional information.
• Ensure CMS and health plan regulatory compliance.
• Document findings accurately in the UM system.
• Meet turnaround times for authorization decisions.
• Participate in quality improvement and audits.
• Collaborate with Case Management and Care Coordination teams.

Skills

CA RN/LVN license

Utilization Management

CMS/Medicare/Medicaid

Independent work

Critical thinking

Fast-paced environment

Job description

Yoh is seeking a Utilization Management Nurse Coordinator (RN or LVN) for a 6+ month remote contract with a managed care client based in Northern California. Training occurs onsite in Fairfield or Redding for three weeks, then transitions to fully remote.

The role reviews outpatient authorizations, assesses medical necessity, and collaborates with interdisciplinary teams to ensure appropriate care while complying with CMS and health plan guidelines.