---
title: 'UM Prior Authorization Nurse, RN at NeueHealth'
canonical: 'https://feeny.ai/job/um-prior-authorization-nurse-rn-neuehealth-remote-skgejy1cr06g'
type: 'job'
last_seen: '2026-09-07'
---

# UM Prior Authorization Nurse, RN at NeueHealth

- **Company:** NeueHealth
- **Location:** Remote
- **Work type:** remote
- **Posted:** 2026-08-25
- **Last confirmed live:** 2026-09-07
- **Apply:** https://job-boards.greenhouse.io/neuehealth/jobs/6162097004

## Job description

## WHO WE ARE

NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

NeueHealth delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.

## 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

The following job description is intended to point out major responsibilities within the role, but it is not limited to these items.

- Authorization and Review
- Evaluate and process prior authorization requests based on clinical guidelines such as Medicare, Medicaid/Medi-Cal criteria, MCG, or health plan-specific guidelines.
- Assess medical necessity and the appropriateness of requested services using clinical expertise.
- Verify patient eligibility, benefits, and coverage details.
- Collaboration and Communication
- Act as a liaison between healthcare providers, patients, and health plans to facilitate the authorization process.
- Communicate authorization decisions to providers and patients promptly.
- Provide detailed explanations for denials or alternative solutions and collaborate with Medical Directors on adverse determinations.
- Ensure compliance with regulatory requirements regarding adverse determination notices, including readability standards and appeal information.
- Documentation and Compliance
- Accurately document all authorization activities in electronic medical records (EMR) or authorization systems.
- Maintain compliance with federal, state, and health plan regulations.
- Stay updated on policy and clinical criteria changes.
- Quality Improvement
- Identify trends or recurring issues in authorization denials and recommend process improvements.
- Participate in team meetings, training sessions, and audits to ensure high-quality performance.

## 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

(List professional knowledge, attitude, and skills required in order to work in the job)

- 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).

## WORK ENVIRONMENT

- The majority of work responsibilities are performed working remotely, carrying out detailed work sitting at a desk/table and working on the computer.
- Collaborative environment requiring frequent communication with clinical and administrative teams.
- Some travel may be required.

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 $74,286.15-$111,429.23 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.

## About NeueHealth

## Company Overview
- **One-liner**: NeueHealth is a value-driven healthcare company that aligns the interests of health consumers, providers, and payors to deliver high-quality, coordinated care across the ACA Marketplace, Medicare, and Medicaid.
- **Entity Type**: Public (NYSE: NEUE) – acquired by New Enterprise Associates in December 2024
- **Headquarters**: Doral, Florida, United States
- **Founded**: 2021 (IPO date; predecessor Bright Health Group founded earlier)
- **Founders**: Not publicly listed as a single founder entity; leadership includes G. Mike Mikan (CEO) and Robert J. Sheehy (Executive Chairman)

## Core Business
- **Primary industry**: Healthcare – value-based care delivery and provider enablement
- **Target customers**: Health consumers (patients), independent providers/medical groups, and payors (health plans, government programs)
- **Mission or purpose**: "Driving value in healthcare for all" – making high-quality, coordinated healthcare accessible and affordable to all populations

## Products & Services
- **NeueCare**: A value-driven care delivery business that manages risk in partnership with external payors. Operates 66 owned primary care clinics (in-person and virtual) in Florida and Texas, with embedded pharmacy, laboratory, radiology, and population health focused specialty services. Serves ACA Marketplace, Medicare, and Medicaid populations.
- **NeueSolutions**: A provider enablement business offering technology, services, and clinical care solutions to independent providers and medical groups. Helps them succeed in performance-based arrangements through financial alignment, population health tools, and partnerships with leading health plans and government programs (including CMMI’s ACO REACH program). Serves approximately 42,000 value-based care consumers.

## Market Standing
- **Valuation/Market Cap**: Acquired by New Enterprise Associates in December 2024 for $1.3 billion (private now). Prior public market cap varied.
- **Key Metric**: Annual Revenue of approximately $890 million (latest available); manages $2.5 billion in medical expense; serves 600,000+ health consumers; works with 3,000+ affiliated providers and 21 payor partners.
- **Notable Investors/Partners**: Parent company is New Enterprise Associates, Inc. (NEA). Key payor partners include leading health plans and government programs (Medicare, Medicaid, ACA Marketplace).
- **Growth Signals**: Acquired Centrum Health in July 2021; headcount of ~106 employees with +4.5% yearly growth; 26,171 LinkedIn followers (+3.6% yearly); 8 active job postings (though down 85.2% year-over-year, indicating post-acquisition consolidation).

## Competitive Advantages
- **Value-driven alignment**: Uniquely aligns interests of consumers, providers, and payors to drive value, rather than volume.
- **Integrated care model**: Owns clinics (NeueCare) and enables external providers (NeueSolutions), creating a hybrid delivery system with embedded pharmacy, lab, and specialty services.
- **Risk management expertise**: Deep experience in performance-based arrangements, including participation in CMMI’s ACO REACH program.
- **Scale and reach**: Serves hundreds of thousands of consumers across multiple insurance programs (ACA, Medicare, Medicaid) with a national provider network.

## Strategic Focus
- **Current priorities**: Advancing value-driven, consumer-centric care; expanding NeueCare clinics in Florida and Texas; deepening NeueSolutions provider enablement tools and partnerships; integrating post-acquisition operations under NEA ownership.
- **Direction for growth**: Scaling performance-based arrangements with payors, increasing the number of affiliated providers, and improving health outcomes for all populations served.

## Why Work Here
- **Culture highlights**: "Transforming healthcare to make it work the way it should for everyone" – mission-driven environment focused on positive impact. Collaborative work environment with supportive clinical staff (e.g., dedicated Medical Assistant for providers).
- **Remote/hybrid/office policy**: Several roles listed as "Work from home" (e.g., UM Coordinator, Associate, Affiliate Growth). Clinics require in-person presence. Hybrid likely for corporate roles.
- **Notable perks**: Comprehensive benefits including flexible medical/dental/vision plans, virtual visits, Health Savings Account company contributions, 401(k) with competitive match, flexible paid time off, company holidays, Employee Assistance Program (counseling, legal/financial advice). For providers: Monday–Friday schedule with limited/compensated on-call time, guaranteed base salary with annual bonus, sign-on bonus eligibility, annual CME reimbursement.
- **Engineering/technical culture**: Small but growing AI engineering team (Director of AI Engineering listed); technical roles in product, project management, and consulting. Talent drawn from UnitedHealth Group, Bright Health, Optum, Centrum Health, and PwC.

## Sources
1. [NeueHealth.com](https://neuehealth.com/)
2. [NeueHealth Careers Page](https://neuehealth.com/careers)
3. [LinkedIn – NeueHealth](https://www.linkedin.com/company/neuehealth)
4. [Reuters – NeueHealth Inc](https://www.reuters.com/markets/companies/NEUE.N)
5. [NEA Careers – NeueHealth Jobs](https://careers.nea.com/jobs/bright-health)

## Other roles at NeueHealth

- [Claims Review Nurse](https://feeny.ai/job/claims-review-nurse-neuehealth-remote-a4vega8h6md5)
- [Clinical Program Director - Pharmacy Solutions](https://feeny.ai/job/clinical-program-director-pharmacy-solutions-neuehealth-doral-florida-j7pev8rn5cfe) — Doral Florida, United States
- [Associate People Business Partner (Field)](https://feeny.ai/job/associate-people-business-partner-field-neuehealth-dallas-texas-xndwjwk6mmwx) — Dallas Texas, United States / Houston Texas, United States
- [Associate People Business Partner (Field)](https://feeny.ai/job/associate-people-business-partner-field-neuehealth-clermont-florida-ehy9ja202td0) — Clermont Florida, United States / Miami Florida, United States / Orlando Florida, United States
- [Utilization Management Nurse, LVN/LPN](https://feeny.ai/job/utilization-management-nurse-lvn-lpn-neuehealth-remote-811q7gbhy2gh)
- [Utilization Management Nurse, LVN/LPN (Part Time)](https://feeny.ai/job/utilization-management-nurse-lvn-lpn-part-time-neuehealth-remote-2k15a32ppf9g)
- [Oracle EPM Business Systems Analyst](https://feeny.ai/job/oracle-epm-business-systems-analyst-neuehealth-remote-tw460entsxpp)
- [Director, Value Based Programs](https://feeny.ai/job/director-value-based-programs-neuehealth-remote-c0npdkjx99zs)
- [Utilization Management Nurse, LVN/LPN](https://feeny.ai/job/utilization-management-nurse-lvn-lpn-neuehealth-remote-1ddt4phwzx4w)
- [Join our Talent Community!](https://feeny.ai/job/join-our-talent-community-neuehealth-remote-cnhd730fn7cb)