Remote Utilization Review RN, Optum

4 weeks ago

East Providence, United States UnitedHealth Group Full time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and 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 to start Caring. Connecting. Growing together.

Position Details:

  • Location : Telecommuter role, however, this position is aligned with the Eastern time zone

  • Department : Utilization Review Management

  • Schedule : Full time, 40 hours/weekly. Monday through Friday, hours between 8:00AM - 5:00PM

As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. Must currently possess an RN license in the state of residence

Primary Responsibilities:

  • Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria)

  • Discuss cases with facility healthcare professionals to obtain plans-of-care

  • Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management

  • Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level

  • Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners

  • Apply clinical expertise when discussing case with internal and external Case Managers and Physicians

  • Identify delays in care or services and manage with MD

  • Follow all Standard Operating Procedures in end to end management of cases

  • Facilitate timely and appropriate care and effective discharge planning

  • Participate in team meetings, education, discussions, and related activities

  • Maintain compliance with Federal, State and accreditation organizations

  • Identify opportunities for improved communication or processes

  • Participate in audit activities and meetings

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 :

  • Current, unrestricted RN license in the state of residence

  • 3+ years of acute care clinical nursing experience

  • 1+ years of utilization review experience using evidence-based guidelines

  • Demonstrate a proficiency in computer skills - Windows, Teams, Excel (Microsoft Suite), Outlook, clinical platforms

  • Designated workspace and access to install secure high-speed internet via cable / DSL in home

Preferred Qualifications:

  • Bachelor’s degree / BSN

  • Compact nursing license

  • Managed Care experience

  • Experience performing discharge planning

The organization reserves the right to modify position responsibilities at any time, due to business necessity.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

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