Clinical Intake Coordinator Registered Nurse- Temporary

Clinical Intake Coordinator Registered Nurse- Temporary Join to apply for the Clinical Intake Coordinator Registered Nurse- Temporary role at Kern Family Health Care . Be among the first 25 applicants to apply for this full‑time temporary role. Pay will be based on your skills and experience. Talk with your recruiter to learn more. Base pay range $51.00/hr – $51.00/hr Essential Duties and Responsibilities Performs review of requested outpatient and elective prospective inpatient medical services. Under the direction of the UM Outpatient Clinical Supervisor coordinates and refers KHS members for services that are carved out of KHS medical coverage. Assists in the authorization and processing of automatic referral requests. Responsible for written and verbal communication with contract providers and internal KHS staff to promote timely coordination of care and dissemination of KHS policies and procedures. Collaborates with the KHS Member Service Department and the Provider Relations Department regarding quality of care and other grievance issues to facilitate timely problem resolutions. Utilizes clinical guidelines and Medi-Cal criteria to review DME, home care, and outpatient service requests for medical necessity and benefit coverage while processing referral requests. Identifies and refers cases for quality of care, coordination of benefits, and third‑party liability issues as appropriate. Maintains knowledge of covered benefits for all programs. Identifies and refers cases appropriate for various internal programs; shares information as necessary with the Population Health Management team: Case Management, Transitions of Care, Major Organ Transplant, and Community Support Services including Extended Care Management. Identifies authorization issues and brings those requiring attention to the UM Outpatient Clinical Supervisor. Reviews requests for non‑par services and coordinates these with input from the Medical Director based on par provider availability in the member’s geographic area. Selects, formats, proofreads and prints appropriate member and provider denial letters prior to mailing. Determines medical appropriateness and necessity of care using established criteria within mandated turnaround times. Appropriately refers cases that do not meet medical necessity to the Medical Director. Keeps current with California Children’s Services benefits and guidelines for coordination of services. Other duties as determined based on Department needs. Education and Experience 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 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. #J-18808-Ljbffr