Data Entry Question and Answer

$150 $49

Remote Question and Answer

$150 $49

Virtual Assistant Question and Answer

$150 $49

Content Moderator Question and Answer

$150 $49

Customer Service Question and Answer

$150 $49

Video Game Tester Question and Answer

$150 $49

UM Prior Authorization Nurse, RN (Work from home) id-14643

Job Description

Back to Career Site

We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.

We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

JOB SUMMARY

The Utilization Management (UM) Prior Authorization (PA) Nurse is a full-time role with NeueHealth, dedicated to promoting quality and cost-effective outcomes for the designated population. Working in collaboration with Medical Directors and the clinical team, the PA Nurse ensures members receive the appropriate benefit coverage for services requiring prior authorization. Responsibilities include reviewing prior authorizations for treatments, medications, procedures, and diagnostic tests to confirm alignment with contract requirements, coverage policies, and evidence-based medical necessity criteria. The PA Nurse also collects and analyzes utilization data and monitors the quality and appropriate use of services. This role demands clinical expertise, keen attention to detail, and strong communication skills to effectively engage with healthcare providers, patients, and health plans.

DUTIES & RESPONSIBILITIES

EDUCATION AND PROFESSIONAL EXPERIENCE
  • Education: Licensed Registered Nurse (RN) with an active, unrestricted California nursing license required.
  • Experience:
    • Minimum of 2-3 years of clinical nursing experience, with at least 1 year in utilization review, case management, or a related field.
    • Experience in a managed care setting with medical necessity reviews is strongly preferred.
  • Certifications:
    • Preferred: Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), or Accredited Case Manager (ACM).
    • Additional clinical nursing or case management certifications are a plus.

PROFESSIONAL COMPETENCIES
  • Strong analytical and critical thinking skills.
  • Proficiency in medical terminology and pharmacology.
  • Effective written and verbal communication skills.
  • Ability to work independently and collaboratively in a fast-paced environment.
  • Adaptable and self-motivated.
  • Experience with EMR systems and prior authorization platforms.
  • Proficient in Microsoft Office Suite (Word, Excel, Outlook).

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 $74,260.46-$111,390.70 Annually.

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.
Back to blog

Yelp Question and Answer

$150 $49

Amzon Question and Answer

$150 $49

Netflix Question and Answer

$150 $49

Disney Question and Answer

$150 $49

Apple Question and Answer

$150 $49

Southwest Airline Q & A

$150 $49

Delta Airline Q & A

$150 $49

Costco Question and Answer

$150 $49

American Question and Answer

$150 $49

Walmart Question and Answer

$150 $49

Tesla Question and Answer

$150 $49

Google Question and Answer

$150 $49

Related Posts