Utilization Management Nurse Coordinator

Utilization Management Nurse Coordinator (RN or LVN) needed 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 8 am to 5 pm 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 8:00 am to 5:00 pm 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

• 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 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,…