Remote Utilization Management Nurse - Part-Time, Weekend

Neuehealth; Los Angeles (CA); On-site; USD 36,000 - 54,000; Part time

Benefits offered by this job

Health benefits

401(k) with match

Paid time off

Paid holidays

Job summary

NeueHealth is seeking a part-time UM Nurse to promote quality and coordinate care across settings. You will review medical necessity, apply criteria, and collaborate with the Medical Director to ensure timely discharge planning and appropriate transitions of care.

The role requires weekend availability (Saturday and Sunday) and is primarily remote with occasional travel. California LVN license with 2 years in medical management is preferred, along with knowledge of MCG, InterQual, and NCQA

Qualifications

• Associate’s degree in Nursing preferred and active California LVN license.
• Minimum 2 years of experience in medical management clinical functions.
• Working knowledge of MCG, InterQual, and NCQA standards.

Responsibilities

• Perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel.
• Review cases for medical necessity and apply criteria (Medicare, Medicaid/Medi-Cal, InterQual, Milliman, or plan guidelines).
• Collaborate with Medical Director to ensure integrity of adverse determinations.
• Ensure timely discharge planning and communication to transition of care teams.
• Meet or exceed productivity targets and assist non-clinical staff as needed.
• Adhere to policies and perform additional duties as assigned.

Skills

Medical management

Clinical criteria review

InterQual knowledge

Education

Associate’s degree in Nursing (preferred)

Tools

MCG

InterQual

NCQA standards

Job description

NeueHealth is seeking a part-time UM Nurse to promote quality and coordinate care across settings. You will review medical necessity, apply criteria, and collaborate with the Medical Director to ensure timely discharge planning and appropriate transitions of care.

The role requires weekend availability (Saturday and Sunday) and is primarily remote with occasional travel. California LVN license with 2 years in medical management is preferred, along with knowledge of MCG, InterQual, and NCQA