Inpatient Utilization RN – Remote (PST/MST)

Colorado Psychiatric; Sacramento (CA); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Stock purchase program

Incentive programs

Job summary

UnitedHealth Group's Optum unit is seeking a Utilization Review Nurse, RN to perform inpatient utilization management with evidence-based guidelines and medical necessity criteria. The role emphasizes timely review, documentation, and collaboration with physician leadership to coordinate patient care.

The position offers remote work options for those in Pacific or Mountain Time, with weekend and holiday hours required, and a compensation range of hourly $29.00–$52.00 based on experience and

Qualifications

• Current, unrestricted RN license in home state
• 3+ years of clinical nursing in acute care or LTAC
• 1+ years of Utilization Management in hospital/insurance
• Experience applying Medicare/Medicaid guidelines
• Experience with Milliman (MCG) or InterQual guidelines
• Strong documentation and care management system skills
• Proficiency with Microsoft Word and Excel

Responsibilities

• Maintain clinical expertise and apply evidence-based guidelines in reviews
• Perform clinical reviews for medical necessity and appropriate utilization
• Authorize services per contracts and health plan guidelines
• Document reviews with rationale in care management system
• Track utilization, variances, and quality indicators
• Prepare clinical information for case reviews with physician leadership
• Collaborate with care coordination teams for patient needs
• Meet timeliness standards for decisions and authorizations
• Maintain patient confidentiality and professional conduct

Skills

RN license

Utilization Management

Medicare/Medicaid guidelines

Milliman MC(G) guidelines

InterQual guidelines

Documentation skills

MS Word/Excel

Tools

Milliman MC(G)

InterQual

Job description

UnitedHealth Group's Optum unit is seeking a Utilization Review Nurse, RN to perform inpatient utilization management with evidence-based guidelines and medical necessity criteria. The role emphasizes timely review, documentation, and collaboration with physician leadership to coordinate patient care.

The position offers remote work options for those in Pacific or Mountain Time, with weekend and holiday hours required, and a compensation range of hourly $29.00–$52.00 based on experience and