About the role
NeueHealth is hiring a remote Concurrent Utilization Review Nurse to make real-time medical necessity calls on inpatient and skilled nursing stays. You'll pair clinical judgment with InterQual/MCG guidelines to keep authorizations moving, loop in Medical Directors on tougher cases, and help case managers plan safe discharges — all without leaving home, as long as you hold an active California nursing license.
Responsibilities
- Run concurrent reviews of inpatient and skilled nursing admissions using InterQual and MCG criteria to confirm medical necessity and the right level of care
- Read clinical documentation closely and translate it into level-of-care determinations that hold up under audit
- Flag complex or borderline cases to the Medical Director with a clear, well-organized clinical summary and a recommended path forward
- Process authorization requests for hospital admissions, LTAC, inpatient rehab, and skilled nursing placements
- Reach out to treating providers when documentation is incomplete or a treatment plan needs clarifying
- Partner with case managers and social workers on discharge planning, spotting and resolving barriers before they delay a safe discharge
- Keep records audit-ready and compliant with state, federal, NCQA, and URAC standards
- Coach network providers on clinical guidelines and the authorization process so future submissions move faster
Requirements
- Active, unrestricted California nursing license — RN or LVN/LPN (required); BSN preferred
- 2–3+ years of clinical nursing experience, including at least 1 year in utilization review or case management
- Managed care background strongly preferred
- CPUR, CCM, or ACM certification a plus
- Solid working knowledge of medical necessity criteria and clinical guideline sets (InterQual, MCG)
- Comfortable working across EHR systems and standard Microsoft Office tools
- Strong written and verbal communication for provider- and payer-facing conversations
What we offer
- Health insurance
- Life and disability insurance
- 401(k) with employer match
- Paid time off and paid holidays