Remote Utilization Management Nurse (LVN/LPN)

NeueHealth; California; Remote; USD 37,000 - 56,000; Full time

Benefits offered by this job

Health benefits

Life and disability benefits

401(k) with match

Paid Time Off and holidays

Job summary

NeueHealth is seeking a Utilization Management Nurse (LVN/LPN) for a remote role based in California. The position focuses on reviewing prior authorizations, ensuring alignment with coverage policies and medical necessity, and collaborating with providers, patients, and health plans.

Qualifications include an active CA nursing license and 2–3 years of clinical nursing experience with at least 1 year in utilization review.

Qualifications

• Licensed Vocational/Practical Nurse (LVN/LPN) with an active, unrestricted California nursing license required.
• Minimum of 2-3 years of 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 preferred.
• Certifications in CPUR, CCM, or ACM are preferred.
• EMR systems and Microsoft Office proficiency required.

Responsibilities

• Evaluate and process prior authorization requests based on clinical guidelines.
• Assess medical necessity and appropriateness of services.
• Verify patient eligibility, benefits, and coverage details.

Skills

Analytical thinking

Communication

Independent work

Education

Licensed Vocational/Practical Nurse with CA license

Tools

EMR systems

Microsoft Office

Job description

NeueHealth is seeking a Utilization Management Nurse (LVN/LPN) for a remote role based in California. The position focuses on reviewing prior authorizations, ensuring alignment with coverage policies and medical necessity, and collaborating with providers, patients, and health plans.

Qualifications include an active CA nursing license and 2–3 years of clinical nursing experience with at least 1 year in utilization review.