Utilization Management Nurse, LVN/LPN
neuehealth
Utilization Management Nurse, LVN/LPN
neuehealth· Clinical Performance
About this role
WHO WE ARE
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.
SCOPE OF ROLE
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.
ROLE RESPONSIBILITIES
- 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.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Associate’s degree in Nursing, preferred
- Minimum 2 years of experience in medical management clinical functions.
- Working knowledge of MCG, InterQual, and NCQA standards
LICENSURES AND CERTIFICATIONS
- Active and Unrestricted License as a Licensed Vocational Nurse (LVN) for California
- Certification Managed Care Nursing (CMCN) preferred
WORK ENVIRONMENT
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
- Some travel may be required.
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. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $26.35-$39.53 Hourly.
Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; Paid Time Off, and paid holidays.
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. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
Frequently Asked Questions
What is the salary for the Utilization Management Nurse, LVN/LPN role at neuehealth?
The listed salary for this Utilization Management Nurse, LVN/LPN position at neuehealth is USD 26–40. This is a remote full-time role.
Is the Utilization Management Nurse, LVN/LPN job at neuehealth remote?
Yes, this Utilization Management Nurse, LVN/LPN position at neuehealth is remote, with team members based in Remote. You can work from home or anywhere in the supported regions.
Which team or department does the Utilization Management Nurse, LVN/LPN at neuehealth belong to?
This Utilization Management Nurse, LVN/LPN position is part of the Clinical Performance department at neuehealth. See the full job description for more information about the team structure and responsibilities.
How do I apply for the Utilization Management Nurse, LVN/LPN position at neuehealth?
Click the "Apply Now" button on this page. You will be redirected to neuehealth's official application portal hosted on greenhouse where you can submit your application directly.
When was the Utilization Management Nurse, LVN/LPN job at neuehealth posted?
This Utilization Management Nurse, LVN/LPN position at neuehealth was posted on Aug 13, 2026. Apply as soon as possible — early applications are often reviewed first.
Utilization Management Nurse, LVN/LPN
neuehealth · 💰 USD 26–40
You'll be redirected to neuehealth's official application page on Greenhouse.