Registered Nurse, Utilization Management

About the Role

We're looking for an RN who enjoys using their clinical judgment without bedside stress. In this role, you'll review outpatient and homebased service requests—such as DME, home health, therapies, and procedures—to help determine medical necessity and ensure our members receive the right care at the right time. This is a great role for an RN who likes chart review, problem solving, and collaborating with providers—while enjoying predictable hours and a supportive team environment.

• Review outpatient and homebased service requests to determine medical necessity using clinical guidelines and Medi Cal criteria.
• Complete initial intake review and route cases to the Medical Director when criteria are not met.
• Serve as a resource for nonclinical intake staff who need clinical support or help interpreting guidelines.
• Communicate with providers to request missing documentation or clarify clinical information.
• Prepare accurate member and provider letters for approvals and denials.
• Coordinate closely with Case Management, Care Transitions, Transplant, and Community Support programs.
• Identify potential quality‑of‑care issues and escalate them appropriately.
• Maintain up‑to‑date knowledge of covered benefits and California Children’s Services (CCS) criteria.

• No bedside or physical labor—fully clinical thinking work.
• Predictable daytime schedule.
• Supportive UM team and strong collaboration.
• Use your nursing knowledge in a new way.
• Growth opportunities within Utilization Management and Case Management.

• Active California RN license.
• Strong clinical assessment and critical‑thinking skills.
• Ability to interpret clinical guidelines and documentation.
• Excellent communication and organization skills.
• Experience in managed care or utilization management is helpful, but not required—we will train the right RN.

Occasional local travel (up to 20 miles) to gather documentation or support care coordination. Mileage reimbursed. This is not a daily requirement.

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)

This is a fully onsite position in Bakersfield, CA.

This position is anticipated to close on Mar 16, 2026.

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