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← NeueHealth

UM Prior Authorization Nurse, RN

NeueHealth
Location
Remote
Posted
26 days ago
Department
Clinical Performance
Salary
$74,286.15-$111,429.23
What they actually want (must-haves)
  • Licensed Registered Nurse (RN) with an active, unrestricted California nursing license
  • Minimum of 2-3 years of clinical nursing experience
  • At least 1 year in utilization review, case management, or a related field
  • Strong analytical and critical thinking skills
  • Proficiency in medical terminology and pharmacology
  • Effective written and verbal communication skills
Nice to have
  • Experience in a managed care setting with medical necessity reviews
  • Certified Professional in Utilization Review (CPUR)
  • Certified Case Manager (CCM)
  • Accredited Case Manager (ACM)
  • Additional clinical nursing or case management certifications
What the job really is

The UM Prior Authorization Nurse at NeueHealth is responsible for evaluating and processing prior authorization requests to ensure appropriate benefit coverage for services. This role involves collaboration with Medical Directors and healthcare providers, assessing medical necessity, and maintaining compliance with regulations. The nurse will also document authorization activities and participate in quality improvement initiatives.

Benefits
  • Health benefits
  • Life and disability benefits
  • 401(k) savings plan with match
  • Paid Time Off
  • Paid holidays
Things to weigh
  • Remote work environment with some travel required
  • Compensation range provided only for California applicants
  • Role requires strong communication skills due to frequent interactions with various stakeholders
Job score4/5
Benefits3/5
Freshness4/5
Career value4/5
Role clarity4/5
Pay transparency5/5

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