Utilization Management Nurse (RN)

Yoh, A Day & Zimmermann Company; Fairfield (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a leading company as a Utilization Management Nurse (RN) in a remote contract role based in Fairfield, CA. You will evaluate care appropriateness, conduct claims reviews, and ensure high-quality healthcare delivery. The position offers competitive hourly pay and includes comprehensive benefits once eligibility is met.

Benefits

Medical, Dental & Vision Benefits

401K Retirement Saving Plan

Life & Disability Insurance

Direct Deposit & weekly EPayroll

Employee Discount Programs

Referral Bonus Programs

Certification and training opportunities

Qualifications

• Active and unrestricted California RN license.
• One year of Managed Care Utilization Management experience required.
• Ability to work within an interdisciplinary structure.

Responsibilities

• Conducts retrospective claims review and summaries findings.
• Evaluates appropriateness of care and provides recommendations.
• Documents and maintains patient-specific records.

Skills

Utilization Management Experience

Organizational skills

Communication skills

Critical thinking skills

Attention to detail

Education

Associate’s degree in Nursing

Bachelor’s degree in Nursing

Job description

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Utilization Management Nurse (RN) needed for a remote contract opportunitywith Yoh’s client located in Fairfield, CA!
Top Skills You Should Possess:

• Utilization Management Experience required
• Must be based in California and able to do in-person training in Fairfield, CA for a few weeks M-F, 8:00am-5:00pm

What You’ll Be Doing:

• Conducts retrospective claims review, either in the aggregate or on an individual basis. Provides summaries of findings to the Team Manager UM.
• Evaluates appropriateness of care through interpretation of benefits as outlined in Title 22, Medi-Cal Provider Manual, DMHC and/or CMS regulatory requirements and policies and procedures for each product line.
• Recommends and coordinates interventions to facilitate high quality, cost-effective care, monitoring treatment, progress and outcomes of patients.
• Documents and maintains patient-specific utilization management records in database and files.
• Participates in special projects and assignments as required.
  

What You Need to Bring to the Table:

• Active and unrestricted California RN license
• Associate’s degree in Nursing required; Bachelor’s degree in Nursing (or higher) preferred
• One (1) year of Managed Care Utilization Management experience required
• Strong organizational, communication, critical thinking skills and attention to detail required
• Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines
• Effective telephone and computer data entry skills required
  

Any pay ranges displayed are estimations which may have been provided by job boards. 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.

What’s InIt For You?
We welcome you to be a part of the largest 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.

• Medical, Dental & Vision Benefits
• 401K Retirement Saving Plan
• Life & Disability Insurance
• Direct Deposit & weekly EPayroll
• Employee Discount Programs
• Referral Bonus Programs

What are you waiting for? Apply Now!
Recruiter: Annie Gill
Yoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK.


Estimated Min Rate: $43.05
Estimated Max Rate: $61.50


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.

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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