LTSS Utilization Management RN - Remote

Lensa; Fort Lauderdale (FL); Remote; USD 59,000 - 117,000; Full time

Job summary

A leading career site is seeking a Registered Nurse for a role focused on utilization management and patient care. This position offers the flexibility of remote work for residents in Florida, with responsibilities including case management and collaboration with medical directors. Candidates must possess an unrestricted RN license and relevant clinical experience, with a competitive salary range and comprehensive benefits.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Qualifications

• 1+ years of managed care and/or clinical experience.
• Experience preferably within Medicaid and Utilization Management.
• Experience creating, editing, and sending documents using Microsoft Office.

Responsibilities

• Perform utilization management and concurrent review.
• Determine medical necessity for in-home LTC services.
• Provide explanations and information on complex issues.

Skills

Utilization Management

Critical Analysis

Communication

Collaboration

Education

Unrestricted RN license

Undergraduate degree

Tools

Microsoft Office

Windows environment

Job description

1 day ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

If you reside in the state of FL, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities

• Perform utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management)
• Determine medical necessity for in home LTC services and support
• Identify solutions to non-standard requests and problems
• Work with minimal guidance; seeks guidance on only the most complex tasks
• Translate concepts into practice
• Provide explanations and information to others on difficult issues
• Coach, provide feedback and guide others
• Act as a resource for others with less experience
• Critical analysis of case manager UM submission with review of supporting tools
• Communication and collaboration with Medical Director
• Case preparation and presentation for Medical Director review
• Documentation in f supportive rationale for UM decision
• Timely and accurate documentation in database of UM decision
  
  

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 required in state of residence
• 1+ years of managed Care and / or Clinical experience preferably working within Medicaid and Utilization Management
• 1+ years of Medicaid Utilization Management experience
• 1+ years of experience creating, editing, saving and sending documents utilizing Microsoft Office (Word, Excel, PowerPoint)
• 1+ years of experiencing navigating in a Windows environment
  
  

Preferred Qualifications

• Undergraduate degree
• State Medicaid Managed Care experience
• Pre-authorization experience
• Utilization Management experience
• Case Management experience
• Experienced in Medicare utilization management
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. 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.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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