UM Clinical Intake Coordinator RN

About The Role

We’re looking for a compassionate and detail‑oriented RN to join our Utilization Management team as a Clinical Intake Coordinator . In this role, you’ll support the coordination of care for our members by reviewing service requests, ensuring medical necessity, and partnering with internal and external healthcare professionals. This is an excellent opportunity for an RN who enjoys a balance of clinical judgment, administrative coordination, and meaningful communication with providers and internal teams.

• Serve as a key point of communication with contracted providers and internal staff to ensure timely coordination of care and clear interpretation of policies and procedures.
• Partner with Member Services and Provider Relations to resolve quality‑of‑care issues and grievances efficiently.
• Review DME, home health, and outpatient service requests using clinical guidelines and Medi‑Cal criteria to determine medical necessity.
• Identify and refer cases related to quality of care, coordination of benefits, and third‑party liability when needed.
• Maintain up‑to‑date knowledge of covered benefits across all health programs.
• Collaborate with internal programs such as Case Management, Transitions of Care, Major Organ Transplant, Community Support Services, and Enhanced Care Management by routing cases appropriately.
• Identify authorization challenges and elevate concerns to the UM Outpatient Clinical Supervisor.
• Review and coordinate requests for non‑participating provider services, consulting with the Medical Director to ensure members are connected with eligible in‑network options.
• Prepare, proofread, and send accurate member and provider denial letters.
• Assess medical appropriateness and medical necessity within mandated turnaround times using established criteria.
• Refer cases that do not meet clinical criteria to the Medical Director for final determination.
• Stay current with California Children’s Services (CCS) guidelines and program benefits.
• Perform additional duties as needed to support departmental operations.

• Active RN license in the state of California.
• Strong clinical judgment with the ability to interpret clinical guidelines and benefit criteria.
• Excellent communication skills — both written and verbal.
• Ability to multitask, stay organized, and work efficiently in a fast‑paced environment.
• Experience in managed care or utilization management is a plus.

This is a Contract to Hire position based out of Bakersfield, CA.

The pay range for this position is $51.00 - $51.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre‑tax and Roth post‑tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long‑term disability
• Health Spending Account (HSA)
• Transportation benefits
  
  Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type:
This is a fully onsite position in Bakersfield, CA. Final date to receive applications:
This position is anticipated to close on Mar 9, 2026.

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That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.