Utilization Management Nurse, LVN/LPN

🔥 37 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $26 - $39 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

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NeueHealth

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💸 Finance

Healthcare • Healthcare Insurance • Finance

NeueHealth is a healthcare company focused on providing accessible, affordable, and high-quality care to all health consumers. Formerly known as Bright Health, it operates through two primary segments: NeueCare, which delivers comprehensive healthcare services via owned and affiliated clinics, and NeueSolutions, which supports independent providers in performance-based care arrangements. With a strong emphasis on understanding patient needs, NeueHealth aims to align the interests of health consumers, providers, and payors to enhance healthcare experiences and outcomes.

📋 Description

• Capacity to perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of members • Capacity to review cases for medical necessity and apply the appropriate clinical criteria; to include, but not limited to Medicare criteria, Medicaid/Medi-cal criteria, Interqual, Milliman, or Health Plan specific guidelines • Capacity to collaborate with the Medical Director to ensure the integrity of adverse determination notices based on the quality standards for adverse determinations • Capacity to ensure discharge planning is timely and appropriately communicated to transition of care teams, when applicable. • Capacity to meet or exceed productivity targets set forth • Capacity to serve as a resource to non-clinical team members when applicable • Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned.

🎯 Requirements

• Associate’s degree in Nursing, preferred • Minimum 2 years of experience in medical management clinical functions. • Working knowledge of MCG, InterQual, and NCQA standards • Active California and Unrestricted License as a Licensed Vocational Nurse (LVN) • Certification Managed Care Nursing (CMCN) preferred

🏖️ Benefits

• Health benefits • Life and disability benefits • 401(k) savings plan with match • Paid Time Off • Paid holidays