Real-Time Utilization Review RN | Care Coordination

NeueHealth; United States; In loco; USD 74.000 - 111.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health benefits

Life and disability benefits

401(k) savings plan with match

Paid Time Off

Paid holidays

Descrizione del lavoro

NeueHealth is seeking a Concurrent Utilization Review (UR) Nurse in California to conduct real-time clinical reviews ensuring medical necessity and appropriate care under a managed care plan. Collaborate with the Medical Director on complex cases, denials, and escalated reviews, and coordinate authorizations for inpatient and post-acute services.

You will participate in care coordination, documentation, and provider education while ensuring compliance with regulatory and accreditation standards.

Competenze

• Active RN license in California
• Experience in utilization review or case management in managed care is preferred
• Knowledge of InterQual/MCG guidelines and medical necessity criteria

Mansioni

• Perform real-time concurrent reviews to assess medical necessity
• Coordinate with Medical Director for complex cases and escalations
• Process authorizations for inpatient admissions and other services
• Communicate with providers and payers to obtain documentation
• Maintain accurate documentation of reviews and denials
• Educate staff on guidelines and authorization processes
• Support discharge planning and care transitions

Conoscenze

Nursing

Utilization Review

Case Management

InterQual/MCG

EHR Proficiency

Communication

Formazione

RN with CA license

BSN preferred

Strumenti

CPUR

CCM

ACM

Descrizione del lavoro

NeueHealth is seeking a Concurrent Utilization Review (UR) Nurse in California to conduct real-time clinical reviews ensuring medical necessity and appropriate care under a managed care plan. Collaborate with the Medical Director on complex cases, denials, and escalated reviews, and coordinate authorizations for inpatient and post-acute services.

You will participate in care coordination, documentation, and provider education while ensuring compliance with regulatory and accreditation standards.