FREE ACCESS
5,000–10,000 jobs/day
See all jobs on JobTailor
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Utilization Management Nurse, LVN/LPN
NeueHealthUtilization Management Nurse reviewing medical necessity and coordinating care for NeueHealth, a value-driven healthcare company. Applying clinical criteria and supporting quality, cost-effective outcomes across care settings.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical management and care coordination, ensuring quality patient-centered outcomes while adhering to Medicare, Medicaid, and health-plan-specific criteria. Proficient in collaborating with clinical teams and managing discharge planning processes.
Highest-signal resume keywords
California Licensed Vocational Nurse (LVN)Medical Necessity ReviewsManaged Care Nursing Certification (CMCN)InterQual StandardsMCG Standards
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care CoordinationPatient-Centered CareMedical ManagementQuality ManagementDischarge PlanningIntervention Efficacy MonitoringProspective Medical Necessity ReviewsRetrospective Medical Necessity ReviewsConcurrent Medical Necessity ReviewsAdvocacy for Services
Soft Skills
CollaborationCommunicationResourcefulnessAdvocacyProductivity Focus
Certifications & Qualifications
Managed Care Nursing Certification (CMCN)
Industry Keywords
MedicareMedicaidMedi-CalInterQualMillimanNCQA StandardsQuality Management CommitteeCare ContinuumTransition of CareClinical Functions
About the role
Key responsibilities & impact- Promote quality, cost-effective outcomes for a population through collaboration and coordination across care settings
- Identify member needs, plan for care, monitor intervention efficacy, and advocate for required services and resources
- Provide patient-centered care across the care continuum
- Perform prospective, retrospective, or concurrent medical necessity reviews for assigned members
- Review cases for medical necessity and apply Medicare, Medicaid/Medi-Cal, InterQual, Milliman, or health-plan-specific criteria
- Collaborate with the Medical Director on adverse determination notices
- Ensure timely and appropriate communication of discharge planning to transition-of-care teams
- Meet or exceed productivity targets
- Serve as a resource to non-clinical team members
- Follow Quality Management Committee policies and procedures and perform additional assigned duties
Requirements
What you’ll need- Associate’s degree in Nursing, preferred
- Minimum 2 years of experience in medical management clinical functions
- Working knowledge of MCG, InterQual, and NCQA standards
- Active and unrestricted California Licensed Vocational Nurse (LVN) license
- Certification Managed Care Nursing (CMCN), preferred
- Some travel may be required
Benefits
Comp & perks- Health benefits
- Life and disability benefits
- 401(k) savings plan with match
- Paid Time Off
- Paid holidays