Real-Time Utilization Review RN – Inpatient Care Advocate

NeueHealth; Minneapolis (MN); On-site; USD 90,000 - 110,000; Full time

Job summary

NeueHealth is seeking a Concurrent Utilization Review (UR) Nurse to perform real-time clinical reviews ensuring medical necessity and appropriate care under our managed health plan. You will assess inpatient and SNF stays, coordinate with providers, and communicate with payers, aligning with clinical guidelines and health plan policies.

You will collaborate with the Medical Director on complex cases, provide detailed case summaries, and ensure timely authorizations while maintaining compliance

Qualifications

• RN license with active, unrestricted California license and BSN.
• Experience in utilization management and concurrent review preferred.

Responsibilities

• Conduct inpatient and skilled nursing reviews to determine medical necessity based on guidelines (InterQual, MCG).
• Collaborate with Medical Director for complex cases and provide comprehensive summaries for care decisions.
• Process authorizations for inpatient admissions, LTAC, inpatient rehab, and SNF, and communicate with providers for required documentation.
• Maintain accurate documentation of all concurrent review activities and support quality improvement initiatives.
• Educate providers and staff on guidelines, authorization processes, and escalation procedures.

Skills

Clinical review

Payer communication

Regulatory compliance

InterQual/MCG

Education

RN license (California)

BSN

Job description

NeueHealth is seeking a Concurrent Utilization Review (UR) Nurse to perform real-time clinical reviews ensuring medical necessity and appropriate care under our managed health plan. You will assess inpatient and SNF stays, coordinate with providers, and communicate with payers, aligning with clinical guidelines and health plan policies.

You will collaborate with the Medical Director on complex cases, provide detailed case summaries, and ensure timely authorizations while maintaining compliance