[Hiring] Utilization Management Nurse, LVN/LPN @NeueHealth

Role Description

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
• Advocating to ensure members 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. This is a part-time position that requires availability to work weekends (Saturday and Sunday).

Qualifications

• Associate’s degree in Nursing, preferred
• Minimum 2 years of experience in medical management clinical functions
• Working knowledge of MCG, InterQual, and NCQA standards

Requirements

• 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

Licensures and Certifications

• Active California and Unrestricted License as a Licensed Vocational Nurse (LVN)
• Certification Managed Care Nursing (CMCN) preferred

Benefits

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

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.

Compensation

A reasonable estimate of the compensation range for this position is $26.35-$39.53 Hourly. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity.