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NeueHealth
Concurrent Utilization Review Nurse, RN
Remote · Full time · Mid level
$74.3k–$111k / year
About the role
Conduct real-time clinical reviews to ensure medical necessity and appropriateness of healthcare services under managed care plans. Collaborate with providers, payers, and clinical leadership to support utilization management and care coordination.
What you’ll do
• Conduct timely inpatient and skilled nursing service reviews. • Evaluate clinical documentation for level-of-care decisions. • Process authorization requests and communicate with providers. • Collaborate with Medical Director on complex cases. • Support discharge planning and care transitions.
What you’ll bring
• Active unrestricted California RN license required. • 2-3 years clinical nursing experience. • At least 1 year in utilization review or case management. • Knowledge of clinical guidelines like InterQual, MCG. • Preferred CPUR, CCM, or ACM certification.
Life at NeueHealth
Employees receive health, life, disability benefits, 401(k) with match, paid time off, and holidays. Diverse and inclusive workplace.
About NeueHealth
NeueHealth is a value-driven healthcare company focused on accessible, affordable, coordinated care across ACA Marketplace, Medicare, and Medicaid populations.