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Utilization Management Clinical Intake Coordinator, RN, I

Clinical Intake Coordinator RN I

Date: 10/10/2014

Description: Under the direction of the Kern Health Systems Director of Health Services and the UM Clinical Supervisor,  the RN Clinical Intake Coordinator is responsible for supporting the clinical Utilization Management activities for KHS members.  The CIC RN I Conducts medical necessity review of referral requests including but not limited to requests for DME, outpatient therapies, and prior authorizations for inpatient and outpatient procedures. Utilizes Milliman and Medicaid criteria to facilitate decision making. Refers cases to the KHS Medical Director when clinical information does not support medical necessity. Functions as a key resource to the LVN Clinical Intake Coordinators for questions or clarifications on criteria, interpretation of benefits, or when needing additional clinical expertise and/or guidance.

Sign On Bonus 2,000

Requirements: Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required. Experience working with patients and caregivers regarding self-care and disease management required. 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. Bachelor’s Degree from an accredited school or equivalent in Nursing, Health Administration or related healthcare field preferred. California Nurse Practitioner license a plus. Registered Nurse with an active, current, unrestricted license. Valid California Driver License and proof of State required auto liability.  Bilingual (English/Spanish) preferred.

We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits.  As a condition of employment, a satisfactory drug test and background check are required. E.O.E.

Req# 176-14