Remote Utilization Management Nurse - Weekend Coverage

NeueHealth; United States; Remote; USD 36,299 - 54,456; 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 on a remote basis. The role requires weekend availability and focuses on medical necessity reviews, care planning, and collaboration with the Medical Director to ensure timely transitions of care.

The ideal candidate has 2+ years in medical management, knowledge of MCG/InterQual/NCQA standards, and carries an active California LVN license; travel may be required.

Qualifications

• 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 of members.
• Review cases for medical necessity using Medicare, Medicaid/Medicaid, InterQual or plan guidelines.
• Collaborate with Medical Director to ensure integrity of adverse determinations.
• Ensure discharge planning is timely and communicated to transition of care teams.
• Meet or exceed productivity targets set forth.
• Serve as a resource to non-clinical team members when applicable.
• Adhere to policies of the Quality Management Committee and perform other duties as assigned.

Skills

Medical management knowledge

InterQual knowledge

NCQA standards

MCG criteria

Education

Associate’s degree in Nursing, preferred

Tools

MCG

InterQual

Job description

NeueHealth is seeking a part-time UM Nurse to promote quality and coordinate care across settings on a remote basis. The role requires weekend availability and focuses on medical necessity reviews, care planning, and collaboration with the Medical Director to ensure timely transitions of care.

The ideal candidate has 2+ years in medical management, knowledge of MCG/InterQual/NCQA standards, and carries an active California LVN license; travel may be required.