NeueHealth

NeueHealth

Utilization Management Nurse, LVN/LPN

California, United States

Sponsorship not specified$26k-$40kDetected 18 hours ago
Patient CareCollaboration

About the role

  • By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
  • We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally.
  • The UM Nurse is responsible for providing patient centered care across the care continuum.

Responsibilities

  • Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned.

Requirements

  • Some travel may be required.
  • Associate's degree in Nursing, preferred

Compensation

  • For individuals assigned to a location(s) in California, NeueHealth is required by law to include a reasonable estimate of the compensation range for this position.

Benefits

  • NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care.
  • NeueHealth delivers clinical care to health consumers through our owned clinics - Centrum Health and Premier Medical - as well as unique partnerships with affiliated providers across the country.
  • Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.
  • Minimum 2 years of experience in medical management clinical functions.
  • Capacity to perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of members
  • Capacity to collaborate with the Medical Director to ensure the integrity of adverse

Company info

  • NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
  • NeueHealth delivers clinical care to health consumers through our owned clinics - Centrum Health and Premier Medical - as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.
  • The role of the UM Nurse is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member's receive services and resources required to meet desired health and social outcomes. The UM Nurse is responsible for providing patient centered care across the care continuum.
  • The role of the UM Nurse is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member's receive services and resources required to meet desired health and social outcomes.
  • 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
  • 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
  • Working knowledge of MCG, InterQual, and NCQA standards
  • Active and Unrestricted License as a Licensed Vocational Nurse (LVN)
  • Certification Managed Care Nursing (CMCN) preferred

Equal opportunity

  • As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve.
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This listing is sourced directly from NeueHealth's careers page and normalized into a canonical job model.