Remote Utilization Management RN

Neuehealth; Los Angeles (CA); On-site; USD 74,000 - 111,000; Full time

Benefits offered by this job

Health benefits

Life & disability benefits

401(k) with match

Paid time off

Paid holidays

Job summary

NeueHealth seeks a full-time Utilization Management (UM) Prior Authorization (PA) Nurse in California. You will review and authorize prior authorizations for treatments, medications, and tests, ensuring alignment with contract requirements, coverage policies, and medical necessity criteria.

You will collaborate with Medical Directors and clinical teams to promote quality and cost-effective outcomes. Requirements include California RN license, 2–3 years of clinical nursing with at least 1 year in

Qualifications

• CA RN license required.
• 2-3 years of clinical nursing experience with at least 1 year in utilization review, case management, or related field.
• Experience in managed care with medical necessity reviews preferred.
• CPUR/CCM/ACM certifications preferred.

Responsibilities

• Authorization and review of prior authorization requests based on clinical guidelines.
• Assess medical necessity and appropriateness of requested services.
• Verify patient eligibility, benefits, and coverage details.
• Act as liaison between providers, patients, and health plans to facilitate authorization.
• Communicate authorization decisions to providers and patients.
• Document all authorization activities in EMR and comply with regulations.
• Identify trends in denials and participate in process improvements.

Skills

Analytical skills

Medical terminology

Pharmacology

Written & verbal communication

Independent & collaborative work

EMR systems

Prior authorization platforms

MS Office

Education

RN license (California)

Tools

CPUR Certification

CCM Certification

ACM Certification

Job description

NeueHealth seeks a full-time Utilization Management (UM) Prior Authorization (PA) Nurse in California. You will review and authorize prior authorizations for treatments, medications, and tests, ensuring alignment with contract requirements, coverage policies, and medical necessity criteria.

You will collaborate with Medical Directors and clinical teams to promote quality and cost-effective outcomes. Requirements include California RN license, 2–3 years of clinical nursing with at least 1 year in