[Hiring] Utilization Management Nurse @Curana Health

Role Description

The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The role includes providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures. This includes:

• Providing prior authorizations
• Concurrent review
• Proactive discharge/transition planning
• High dollar claims review

There is a heavy emphasis on concurrent review and proactive transition planning for members in the hospital and skilled nursing facility. This is primarily a remote telephonic position with normal business day hours, with one weekend day per month coverage. This position serves as a liaison to the Plan Medical Director working closely with appeals and medical decisions.

Qualifications

• Minimum 2 years clinical experience as RN, LPN/LVN required
• Minimum 1-year managed care or equivalent health plan experience preferred
• Demonstrated experience in health plan utilization management, facility concurrent review discharge planning, and transfer coordination required
• Medicare Advantage experience preferred
• Experience with InterQual or MCG authorization criteria preferred
• Excellent computer skills and ability to learn new systems required
• Strong attention to detail, organizational skills and interpersonal skills required
• Demonstrated ability to problem solve and manage professional relationships

Requirements

• Active unrestricted Nursing license required

Company Description

Curana Health is a national leader in value-based care, offering senior living communities and skilled nursing facilities a wide range of solutions proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we've grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for.

Ranked #147 on the Inc. 5000 list of America's fastest-growing private companies, we're just getting started. If you're looking to make a meaningful impact on the senior healthcare landscape, you're in the right place—and we look forward to working with you.

For more information about our company, visit CuranaHealth.com.