Concurrent Utilization Review Nurse, RN

NeueHealth
California, CA
Job Description
NeueHealth is a healthcare company seeking a Concurrent Utilization Review (UR) Nurse to conduct real-time clinical reviews and ensure medical necessity for managed care health plans. The role involves assessing inpatient admissions, collaborating with medical professionals, and ensuring compliance with policies. The UR Nurse will work with the Medical Director and clinical leadership for complex cases, denials, and escalations.

Requirements

  • Registered Nurse (RN) with active, unrestricted California nursing license required
  • Minimum of 2-3 years of clinical nursing experience, with at least 1 year in utilization review
  • Strong knowledge of clinical guidelines and medical necessity criteria
  • Proficiency in electronic health records (EHR) and utilization management software

Benefits

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