What are the responsibilities and job description for the Utilization Management Coordinator position at All's Well Health Care Services?
Job Overview
The Utilization Management (UM) Clinical Intake Coordinator RN I is a registered nurse responsible for reviewing and coordinating healthcare service requests to ensure they meet clinical and regulatory standards. This role involves:
Duties
- Evaluating medical necessity of referrals and authorizations.
- Applying clinical guidelines (e.g., Medicaid, Milliman criteria).
- Supporting intake staff with clinical expertise.
- Communicating with providers and internal teams.
- Escalating complex cases to medical directors when needed.
Education and Experience:
- Bilingual (English/Spanish) preferred –Not Required
- Registered Nurse (RN) with an active, current, unrestricted CA license
- Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required
- Experience with MCG Health LLC clinical guidelines and Medi-CAL coverage
- Bachelor’s Degree from an accredited school or equivalent in Nursing, Health Administration or related healthcare field preferred
- Understanding of utilization management principles
- Experience working in case management or care coordination is a plus
- Knowledge of Kern County Community resources for seniors and people with disabilities is a plus.
Job Type: Temporary
Pay: $45.00 - $51.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Vision insurance
Work Location: In person
Salary : $45 - $51