Utilization Management Nurse Coordinator

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

Utilization Management Nurse Coordinator (RN or LVN)

We are looking for a temp 6+ month, remote contract opportunity with Yoh’s managed care health plan client based out of Redding or Fairfield, CA. Anticipating to be temporary for at least 6 months with potential for temp-to-hire. Multiple openings available!

Training will be onsite (in either Fairfield or Redding) for the first 3 weeks and then will transition to fully remote.

Monday-Friday 8am to 5pm with one weekend per month.

Utilize your clinical expertise to support quality, cost-effective healthcare in a fully remote managed care setting. The UM RN Nurse Coordinator reviews outpatient authorization requests, assesses medical necessity, collaborates with interdisciplinary teams, and helps ensure members receive the right care at the right time while maintaining compliance with regulatory and health plan guidelines.

Top Skills You Should Possess:

• Active/unrestricted Registered Nurse or Licensed Vocational Nurse license in California
• Experience in Utilization Management, Prior Authorization, Case Management, or Managed Care
• Familiarity with CMS, Medicare, Medicaid, and commercial health plan guidelines
• High degree of independence, flexibility, initiative, and commitment
• Solid critical thinking and problem-solving skills
• Ability to work in a fast-paced, member-service oriented environment

What You’ll Be Doing:

• Review outpatient authorization requests using InterQual and established clinical guidelines
• Evaluate medical necessity, appropriateness of treatment, and benefit coverage requirements
• Analyze clinical documentation submitted by providers and facilities
• Approve services within designated RN authority levels and refer complex cases to Medical Directors as needed
• Communicate with providers to obtain additional clinical information required for determinations
• Ensure compliance with CMS, NCQA, DHCS, state, federal, and health plan regulations
• Accurately document review findings in the utilization management system
• Meet turnaround time requirements for authorization decisions
• Participate in quality improvement initiatives and audit activities
• Collaborate with Case Management, Care Coordination, Disease Management, and Provider Relations teams

What You Need to Bring to the Table:

• Must be able to work Monday - Friday 8:00am to 5:00pm with one weekend per month
• At least 3-5 years of clinical nursing experience
• Experience reviewing outpatient authorizations and medical necessity determinations.
• Strong understanding of CMS, Medicare, Medicaid, and Commercial health plan regulations.

What’s In It For You?

• Great work-life balance with this being 100% remote and primarily Mon-Fri
• Work at a company that focuses on mission-driven work with real community impact
• Foot in the door at a company with strong name recognition in Bay Area healthcare
• Competitive compensation with weekly direct deposit every Friday

What’s In It for You?

We welcome you to be a part of the largest and legendary global staffing companies to meet your career aspirations. Yoh’s network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities and gain access to this exclusive opportunity available to you. Benefit eligibility is in accordance with applicable laws and client requirements. Benefits include:

• Medical, Prescription, Dental & Vision Benefits (for employees working 20+ hours per week)
• Health Savings Account (HSA) (for employees working 20+ hours per week)
• Life & Disability Insurance (for employees working 20+ hours per week)
• MetLife Voluntary Benefits
• Employee Assistance Program (EAP)
• 401K Retirement Savings Plan
• Direct Deposit & weekly epayroll
• Referral Bonus Programs
• Certification and training opportunities

Note: Any pay ranges displayed are estimations. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Visit https://www.yoh.com/applicants-with-disabilities to contact us if you are an individual with a disability and require accommodation in the application process.

For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

By applying and submitting your resume, you authorize Yoh to review and reformat your resume to meet Yoh’s hiring clients’ preferences. To learn more about Yoh’s privacy practices, please see our Candidate Privacy Notice: https://www.yoh.com/privacy-notice

Estimated Min Rate

$45.00

Estimated Max Rate

$55.00