RN UM Clinical Intake Coordinator

All’s Well; Bakersfield (CA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

401(k)

Job summary

A healthcare provider in California is seeking an experienced RN Clinical Intake Coordinator to support clinical Utilization Management activities. Responsibilities include conducting medical necessity reviews and providing expertise to coordination teams. Candidates must have an active CA RN license and at least two years of clinical experience. Benefits include medical and vision insurance, along with a 401(k).

Qualifications

• Active RN license in California required.
• Minimum of two years full-time clinical experience in relevant settings.
• Understanding of utilization management principles required.

Responsibilities

• Support clinical Utilization Management activities.
• Conduct medical necessity review of referral requests.
• Serve as a resource for Non-Clinical Intake Coordinators.

Skills

Clinical experience

Knowledge of utilization management principles

Experience with MCG Health clinical guidelines

Care coordination experience

Education

Bachelor’s Degree in Nursing

Job description

Responsibilities

RN Clinical Intake Coordinator is responsible for supporting the clinical Utilization Management activities for members. Conducts medical necessity review of referral requests including but not limited to requests for DME, outpatient therapies, and prior authorizations for outpatient procedures and prospective inpatient stays. Utilizes Milliman and Medicaid criteria to facilitate decision making. Refers cases to the Medical Director when clinical information does not support medical necessity. Functions as a key resource to the Non-Clinical Intake Coordinators for questions or clarifications on criteria, interpretation of benefits, or whenever they need additional clinical expertise and/or guidance.

Qualifications

• Registered Nurse (RN) with an active, current, unrestricted CA license required
• Minimum of two years full‑time clinical experience in acute care, community health setting, public health nursing or chronic disease management required
• Bachelor’s Degree from an accredited school or equivalent in Nursing
• Understanding of utilization management principles required
• Experience with MCG Health LLC clinical guidelines and Medi‑CAL coverage required
• Experience working in case management or care coordination preferred
• Knowledge of Kern County community resources for seniors and people with disabilities preferred

Benefits

Medical insurance

Vision insurance

401(k)