Utilization Management RN
4 weeks ago
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You'll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact
***Although this position is remote, applicants must work Arizona time 8am-5pm PST/MST depending on time of year***
It feels great to have autonomy, and there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact our members. And at the same time, you'll be challenged by leveraging technologies and resources in a rapidly changing, production-driven environment.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Positions in this function require unrestricted RN licensure
- Function is responsible for utilization management which includes Concurrent Review (on-site or telephonic Inpatient Care Management). Performs reviews of current inpatient services
- Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
- Generally, work is self-directed and not prescribed
- Works with less structured, more complex issues
- Identify solutions to non-standard requests and problems
- Translate concepts into practice
- Act as a resource for others; provide explanations and information on difficult issues
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:
- Unrestricted RN license in state of residence
- Compact RN License
- 3+ years of managed care and/or clinical experience
- Willing or ability to work 8am-5pm Arizona Time Zone
- Proven basic computer skills with MS Outlook, Word and Excel
Preferred Qualifications:
- Certified Case Manager (CCM)
- Pre-authorization experience
- Multi-specialty experience
- Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance
- Utilization management experience
- Case management experience
- Knowledge of Milliman criteria
*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, Washington, Washington, D.C. 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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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