Opportunity Description
About the Role
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.
What You’ll Do
+ 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.
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.
What You’ll Do
+ 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.
Ready to Apply?
Submit your application for Registered Nurse, Utilization Management at TEKsystems
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