Prior Authorization Nurse - LVN/LPN (UM & Review)

NeueHealth; Sacramento (CA); Remote; USD 37,000 - 56,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Paid Time Off

Paid holidays

Job summary

NeueHealth is a value-driven healthcare company delivering high-quality, coordinated care through owned clinics and partner networks. The Utilization Management (UM) Prior Authorization (PA) Nurse role is full-time, focused on promoting cost-effective outcomes for the designated population.

You will review prior authorizations, verify coverage, and analyze utilization data in collaboration with Medical Directors and the clinical team.

Qualifications

• LVN/LPN with active, unrestricted California license required.
• 2–3 years clinical nursing experience, with at least 1 year in utilization review, case management, or a related field.
• Experience in a managed care setting with medical necessity reviews is strongly preferred.

Responsibilities

• Evaluate and process prior authorization requests based on clinical guidelines.
• Verify patient eligibility, benefits, and coverage details.
• Accurately document all authorization activities in EMR or authorization systems.
• Collaborate with Medical Directors on adverse determinations and communicate decisions to providers and patients.

Skills

Utilization review

Case management

EMR systems

Medical terminology

Communication

MS Office

Education

LVN/LPN with CA license

Tools

EMR platforms

Authorization platforms

Job description

NeueHealth is a value-driven healthcare company delivering high-quality, coordinated care through owned clinics and partner networks. The Utilization Management (UM) Prior Authorization (PA) Nurse role is full-time, focused on promoting cost-effective outcomes for the designated population.

You will review prior authorizations, verify coverage, and analyze utilization data in collaboration with Medical Directors and the clinical team.