Registered Nurse, Utilization Management

TEKsystems•Bakersfield, CA

4d•$51 - $51•Onsite

About The Position

We’re looking for an RN who enjoys using their clinical judgment without bedside stress. In this role, you’ll review outpatient and home‑based service requests—such as DME, home health, therapies, and procedures—to help determine medical necessity and ensure our members receive the right care at the right time. This is a great role for an RN who likes chart review, problem‑solving, and collaborating with providers—while enjoying predictable hours and a supportive team environment.

Requirements

Active California RN license
Strong clinical assessment and critical‑thinking skills
Ability to interpret clinical guidelines and documentation
Excellent communication and organization skills

Nice To Haves

Experience in managed care or utilization management is helpful, but not required—we will train the right RN

Responsibilities

Review outpatient and home‑based service requests to determine medical necessity using clinical guidelines and Medi‑Cal criteria.
Complete initial intake review and route cases to the Medical Director when criteria are not met.
Serve as a resource for non‑clinical intake staff who need clinical support or help interpreting guidelines.
Communicate with providers to request missing documentation or clarify clinical information.
Prepare accurate member and provider letters for approvals and denials.
Coordinate closely with Case Management, Care Transitions, Transplant, and Community Support programs.
Identify potential quality‑of‑care issues and escalate them appropriately.
Maintain up‑to‑date knowledge of covered benefits and California Children’s Services (CCS) criteria.