RN Clinical Intake Coordinator - Inpatient and Outpatient - On Site
Immediate need for a RN Utilization Management Clinical Intake Coordinator.
In this position the RN will be responsible for supporting the clinical Utilization Management activities for members.

Conducts medical necessity review of referral requests including but not limited to requests for DME, outpatient therapies, and prior authorizations for outpatient procedures and prospective inpatient stays.

Utilizes Milliman and Medicaid criteria to facilitate decision making.
Refers cases to the Medical Director when clinical information does not support
medical necessity.

Functions as a key resource to the Non-Clinical Intake Coordinators for questions or clarifications on criteria, interpretation of benefits, or whenever they need additional
clinical expertise and/or guidance.

REQUIREMENTS:
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.

Bachelor’s Degree from an accredited school or equivalent in Nursing, Health
Administration or related healthcare field preferred.

Understanding of utilization management principles preferred.

Experience with MCG Health LLC clinical guidelines and Medi-CAL coverage
preferred.

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.



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, ALL's WELL 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.