RN Utilization Review Nurse - Inpatient & Payer

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

Benefits offered by this job

Health benefits

401(k) with match

Paid Time Off

Paid holidays

Job summary

NeueHealth seeks a Concurrent Utilization Review (UR) Nurse in California to perform real-time clinical reviews ensuring medical necessity and appropriate care. You will coordinate with providers, payers, and the Medical Director for complex cases and denials.

The role requires an active CA RN license, 2–3 years of clinical nursing, and UR/case-management experience. On-site clinic setting with comprehensive benefits is offered.

Qualifications

• RN with an active California license is required.
• Minimum 2–3 years of clinical nursing experience; UR/case management experience preferred.
• CPUR/CCM/ACM certifications are plus.
• Proficient with clinical guidelines (InterQual, MCG) and EHR tools.

Responsibilities

• Perform real-time concurrent reviews for medical necessity and level of care.
• Collaborate with Medical Director for complex cases and escalations.
• Process authorizations for inpatient and SNF services; communicate with providers.
• Maintain compliant documentation and participate in quality improvement.

Skills

Clinical guidelines

Communication skills

Analytical skills

EHR proficiency

Education

RN license (CA)

BSN preferred

Tools

EHR systems

Utilization management software

MS Office

Job description

NeueHealth seeks a Concurrent Utilization Review (UR) Nurse in California to perform real-time clinical reviews ensuring medical necessity and appropriate care. You will coordinate with providers, payers, and the Medical Director for complex cases and denials.

The role requires an active CA RN license, 2–3 years of clinical nursing, and UR/case-management experience. On-site clinic setting with comprehensive benefits is offered.