RN Utilization Manager in Bakersfield, CA

SCHEDULE: Monday-Friday 8am-5pm,

HOURLY: $49.00 - $51.00 per hour

WORK SETTING: In-person Corporate Office

Job description:

Responsible for reviewing and coordinating healthcare service requests to ensure they meet clinical and regulatory standards.
• 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 & 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

Apply for this great position as a rn utilization manager today!

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here:

https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:

https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

ALL's WELL participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

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