Concurrent UR Nurse RN - Real-Time Case Review

NeueHealth; United States; Remote; USD 85,000 - 105,000; Full time

Job summary

NeueHealth is seeking a CONCURRENT UTILIZATION REVIEW (UR) NURSE to perform real-time clinical reviews ensuring medical necessity for inpatient and continued stays. You will collaborate with the Medical Director and care teams to prepare summaries, justify decisions, and support appropriate transitions of care.

In this role you will process authorizations, communicate with providers and payers, and ensure adherence to NCQA/URAC guidelines and health plan policies.

Qualifications

• Active California RN license required.
• BSN preferred or required.
• Experience in concurrent utilization review is a plus.

Responsibilities

• Perform real-time concurrent reviews for inpatient and skilled nursing services to determine medical necessity.
• Provide comprehensive clinical summaries and justifications for decisions to Medical Director.
• Process authorizations and denials per health plan guidelines and timelines.
• Coordinate with care teams to facilitate transitions of care and discharge planning.
• Educate providers and staff on utilization management guidelines and compliance.

Skills

Inpatient utilization management

Clinical documentation review

Payer communications

Interdisciplinary collaboration

Education

RN license (CA, active/unrestricted)

BSN

Job description

NeueHealth is seeking a CONCURRENT UTILIZATION REVIEW (UR) NURSE to perform real-time clinical reviews ensuring medical necessity for inpatient and continued stays. You will collaborate with the Medical Director and care teams to prepare summaries, justify decisions, and support appropriate transitions of care.

In this role you will process authorizations, communicate with providers and payers, and ensure adherence to NCQA/URAC guidelines and health plan policies.