About ProgenyHealth – Pioneering Neonatal Care Management
ProgenyHealth stands at the forefront of innovative care management solutions for premature and medically complex newborns. Our mission is to ensure that every infant receives the right care at the right time, while simultaneously supporting families, clinicians, and health‑plan partners throughout the first year of life. From neonatal intensive care units (NICUs) to home‑based services, our multidisciplinary team—comprising neonatologists, pediatricians, NICU nurses, social workers, and data analysts—works in seamless coordination to improve outcomes, reduce unnecessary utilization, and lower overall costs. As a remote‑first organization, we leverage cutting‑edge technology, evidence‑based protocols, and a culture of continuous learning to deliver high‑quality, patient‑centered care across the United States.
Why This Role Matters – The Impact of a Utilization Management Nurse
In today’s rapidly evolving healthcare landscape, the role of a Utilization Management (UM) Nurse is more critical than ever. You will act as the clinical bridge between hospitals, health plans, and families, ensuring that every admission, procedure, and discharge is medically appropriate, cost‑effective, and aligned with the latest evidence‑based guidelines. Your decisions will directly influence the health trajectory of vulnerable newborns, helping them transition safely from intensive care to thriving at home. By joining ProgenyHealth, you become part of a purpose‑driven team that saves lives, reduces the emotional and financial burden on families, and advances the standards of neonatal care on a national scale.
Key Responsibilities – What You’ll Do Every Day
- Initiate and oversee the continuum of care for neonatal admissions, from pre‑admission assessments through hospital discharge and post‑acute follow‑up.
- Collect, verify, and synthesize clinical information via telephone and secure electronic messaging with NICU staff, physicians, and allied health professionals to support medical necessity determinations.
- Conduct concurrent reviews of inpatient stays, ensuring that length of stay, level of care, and treatment plans remain justified and aligned with payer policies.
- Authorize and document all required prior authorizations for services across the first year of life, adhering strictly to health‑plan contracts, InterQual/MCG criteria, and URAC/NCQA standards.
- Coordinate discharge planning by collaborating with multidisciplinary teams to develop individualized transition plans, arrange home health services, and educate families on post‑discharge care.
- Serve as a liaison between providers, hospitals, and health plans, facilitating smooth communication, addressing gaps in care, and escalating quality‑of‑care concerns to the Medical Director when necessary.
- Maintain meticulous documentation of all interactions, decisions, and outcomes in the electronic medical record (EMR) and any required databases, ensuring compliance with HIPAA and internal audit requirements.
- Participate in on‑call rotations that may include evenings or weekends, providing timely support for urgent clinical questions and authorization needs.
- Continuously monitor and report utilization trends, contributing data‑driven insights to quality improvement initiatives and program development.
- Stay current with evolving clinical guidelines, payer policies, and emerging neonatal technologies to uphold the highest standards of care.
Essential Qualifications – The Foundations We Require
- Active, unrestricted Registered Nurse (RN) license in the United States.
- Minimum of three (3) years of hands‑on clinical experience in a Level III or IV NICU setting, with demonstrated competence in caring for high‑risk newborns.
- Proven experience in concurrent review, discharge planning, or utilization management within a health‑plan, acute‑care hospital, or similar environment.
- Strong familiarity with payer‑specific utilization criteria, including InterQual and/or MCG guidelines.
- Demonstrated ability to navigate and document in electronic health records (EHR) and data entry platforms with a high degree of accuracy.
- Exceptional written and verbal communication skills, including professional telephone etiquette and the ability to convey complex clinical information clearly.
- Self‑motivation, strong organizational skills, and the capacity to prioritize multiple tasks while maintaining meticulous attention to detail.
- Commitment to providing occasional holiday coverage and flexible weekend availability, as outlined in the schedule.
- Proficiency with standard office software (Microsoft Office Suite, Google Workspace) and comfort with remote‑work technology (VPN, video conferencing, secure messaging platforms).
Preferred Experience & Skills – What Sets Candidates Apart
- Experience applying URAC and/or NCQA accreditation standards in utilization management or quality assurance roles.
- Previous exposure to neonatal case management, family education, or home‑health coordination.
- Certification in Case Management (CCM), Utilization Review (UR), or a related specialty.
- Familiarity with population health analytics tools or dashboards that track utilization metrics.
- Demonstrated ability to lead or contribute to interdisciplinary quality‑improvement projects.
- Fluency in a second language, enhancing communication with diverse patient populations.
- Experience working in a fully remote or hybrid environment, with a proven record of maintaining productivity and team cohesion.
Core Competencies & Attributes for Success
- Clinical Acumen: Deep understanding of neonatal pathophysiology, evidence‑based therapies, and critical care interventions.
- Analytical Thinking: Ability to assess complex clinical data, apply utilization criteria, and make sound, defensible decisions.
- Communication Excellence: Clear, compassionate, and persuasive interaction style that builds trust with providers, families, and payers.
- Adaptability: Comfortable navigating shifting priorities, emerging guidelines, and evolving technology platforms.
- Team Orientation: Collaborative mindset that thrives in multidisciplinary environments and contributes positively to group dynamics.
- Integrity & Compliance: Unwavering commitment to ethical standards, confidentiality, and regulatory adherence.
- Continuous Learning: Proactive pursuit of professional development through certifications, webinars, and industry conferences.
Career Growth & Learning Opportunities – Your Path Forward
ProgenyHealth invests heavily in employee development. As a Utilization Management Nurse, you will have access to a robust learning ecosystem that includes:
- Mentorship from senior clinical leaders and the Medical Director, providing guidance on complex cases and strategic initiatives.
- Paid tuition reimbursement for accredited programs related to nursing, health policy, or health‑information management.
- Quarterly internal workshops covering advanced utilization criteria, emerging neonatal therapies, and quality‑improvement methodologies.
- Opportunities to obtain specialty certifications such as CCM, UR, or Neonatal Nurse Practitioner (NNP) with full company support.
- Potential career pathways into senior clinical leadership, case‑management program direction, or health‑plan partnership roles.
- Cross‑functional project involvement, allowing you to influence product development, policy design, and analytics strategies.
Our commitment to your professional trajectory ensures that you not only excel in your current role but also build a lasting, fulfilling career within the evolving landscape of neonatal health management.
Compensation, Benefits & Perks – What We Offer
- Competitive hourly or salary compensation commensurate with experience and market benchmarks.
- Comprehensive health coverage including medical, dental, and vision plans with low employee contributions.
- Retirement savings through a 401(k) plan with generous company match.
- Paid Time Off (PTO) accruing annually, plus holidays and flexible weekend scheduling.
- Short‑ and long‑term disability insurance and group life coverage for added financial security.
- Professional development stipend for courses, conferences, and certification exams.
- Remote‑work flexibility with a partial or full‑remote schedule, supported by a home‑office stipend and technology provision.
- Business‑casual dress code and a culture that values work‑life balance.
- Team‑building events, virtual coffee chats, and annual gatherings to foster community across locations.
Work Environment & Culture – The ProgenyHealth Experience
At ProgenyHealth, our people are our greatest asset. We champion an inclusive, collaborative, and forward‑thinking environment where diverse perspectives drive innovative solutions. Our remote‑first model encourages autonomy while maintaining strong connections through regular virtual huddles, mentorship circles, and transparent leadership communication. We celebrate milestones—both professional and personal—and strive to create a supportive space where every team member feels valued, heard, and empowered to contribute their best work.
How to Apply – Take the Next Step Toward a Meaningful Career
If you are an experienced NICU RN with a passion for leveraging clinical expertise to enhance utilization outcomes, we invite you to join our mission‑driven team. Click the link below to submit your resume, cover letter, and any relevant certifications. Our recruiting partners are ready to guide you through the process and answer any accommodation requests you may have.
Apply Now – Become a ProgenyHealth Utilization Management Nurse
We Want to Hear From You!
Ready to make a tangible difference in the lives of newborns and their families? Don’t wait—apply today and embark on a rewarding journey with ProgenyHealth, where your expertise fuels better outcomes, stronger partnerships, and a brighter future for the most vulnerable patients. Together, we’ll shape the next generation of neonatal care.
Apply Now