Remote Utilization Management Nurse - LVN/LPN

NeueHealth; Los Angeles (CA); Remote; USD 37.000 - 56.000; Vollzeit

Benefits dieser Stelle

Health benefits

401(k) with match

Paid time off

Zusammenfassung

NeueHealth is hiring a Utilization Management Nurse (LVN/LPN) based in California for a remote, full-time role. The PA Nurse reviews prior authorizations, verifies coverage, and ensures medical necessity under state and plan policies.

You will collaborate with Medical Directors, providers, and plans to resolve denials and improve processes. The position requires 2–3 years of clinical nursing experience, with 1 year in utilization review or case management, and an active CA license.

Qualifikationen

• California LVN/LPN license required.
• 2–3 years of clinical nursing experience with at least 1 year in utilization review or case management.
• Managed care experience and medical necessity review preferred.
• CPUR/CCM/ACM certifications preferred.

Aufgaben

• Authorization and Review: Evaluate and process prior authorization requests based on clinical guidelines and medical necessity.
• Collaboration and Communication: Liaise with providers, patients, and health plans; explain decisions clearly.
• Documentation and Compliance: Record activities in EMR/authorization systems and stay compliant with regulations.
• Quality Improvement: Identify trends in denials and propose process improvements.

Kenntnisse

Utilization review

Case management

Healthcare regulations

Communication

Analytical thinking

Ausbildung

LVN/LPN with CA license

Tools

EMR systems

Microsoft Office

Jobbeschreibung

NeueHealth is hiring a Utilization Management Nurse (LVN/LPN) based in California for a remote, full-time role. The PA Nurse reviews prior authorizations, verifies coverage, and ensures medical necessity under state and plan policies.

You will collaborate with Medical Directors, providers, and plans to resolve denials and improve processes. The position requires 2–3 years of clinical nursing experience, with 1 year in utilization review or case management, and an active CA license.