UM Nurse Coordinator; RN or LVN

Utilization Management Nurse Coordinator(RN or LVN)needed for a temp 6+ month, remote contract
opportunity with Yoh'smanaged care health plan client based out of Fairfield & Redding, 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 weeksand 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.

• 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

• Review outpatient authorization requests using Inter Qual 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

• 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.

• 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

Estimated Min Rate
: $45.00 Estimated Max Rate
: $55.00

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)
• Met Life Voluntary Benefits
• Employee Assistance Program (EAP)
• 401K…