Utilization Management Specialist RN

2 weeks ago

Minneapolis, Minnesota, United States UnitedHealth Group Full time

$1,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS

Opportunities at Optum, in strategic partnership with Allina Health. As an Optum employee, you will provide support to the Allina Health account. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us.

Position in this function reviews medical records and prepares clinical appeals for medical necessity and authorization denials

NOTE: Qualified candidates must live in MN or WI to be considered for this role

If you are located in Minnesota or Wisconsin, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Ensures procedures are appropriate and necessary per health benefit plans
  • Assesses clinical data from medical records to assure appropriateness of patient's admission
  • Utilizes screening criteria to determine patient status
  • Assures the medical record has the proper physician order and/or clinical documentation
  • Assesses claim denials, prepares, facilitates, and monitors appeal process
  • Other duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Registered Nurse (RN) with an active, unrestricted RN license in the state of MN
  • 2+ years of experience in an acute hospital setting
  • Intermediate level of proficiency with Microsoft Office Suite (Outlook, Word, TEAMs, Excel)
  • Reside in the state of MN or WI

Preferred Qualifications:

  • 2+ years of case management experience and/or 2+ years of utilization management experience
  • 6+ months of experience using InterQual, MCG, or other admission criteria
  • Epic Experience

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

*PLEASE NOTE The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.*

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and 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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #Yellow


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