LTSS Utilization Management RN - Remote

UnitedHealth Group; Plantation (FL); Remote; Confidential; Full time

Job summary

UnitedHealth Group is seeking a dedicated RN for a utilization management role that involves assessing medical necessity and coaching colleagues. This position offers remote flexibility for Florida residents and a competitive salary range, along with a comprehensive benefits package. Ideal candidates will have experience in managed care and Medicaid utilization management.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contributions

Qualifications

• Unrestricted RN license in state of residence.
• At least 1 year of managed care and/or clinical experience.
• Experience with Medicaid Utilization Management.

Responsibilities

• Perform utilization management and determine medical necessity.
• Coach and guide less experienced colleagues.
• Document and communicate UM decisions.

Skills

Managed care experience

Clinical experience

Utilization Management

Communication

Critical analysis

Education

Undergraduate degree

Unrestricted RN license

Tools

Microsoft Office

Windows environment

Job description

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. Join us to build a more responsive, affordable, and equitable health care system. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

If you reside in Florida, you will have the flexibility to work remotely* as you take on some challenging tasks.

Primary Responsibilities:

1. Perform utilization management, review, or concurrent review (on-site or telephonic inpatient care management).
2. Determine medical necessity for in-home LTC services and support.
3. Identify solutions to non-standard requests and problems.
4. Work with minimal guidance; seek guidance only on complex tasks.
5. Translate concepts into practice.
6. Provide explanations and information on difficult issues.
7. Coach, give feedback, and guide others.
8. Act as a resource for less experienced colleagues.
9. Critically analyze case manager UM submissions with supporting tools.
10. Communicate and collaborate with Medical Director.
11. Prepare and present cases for Medical Director review.
12. Document supportive rationale for UM decisions.
13. Ensure timely and accurate documentation of UM decisions in the database.

You’ll be rewarded and recognized for your performance in an environment that challenges you, provides clear success criteria, and offers development opportunities for other roles you may be interested in.

Required Qualifications:

1. Unrestricted RN license in your state of residence.
2. At least 1 year of managed care and/or clinical experience, preferably within Medicaid and Utilization Management.
3. At least 1 year of Medicaid Utilization Management experience.
4. Experience creating, editing, saving, and sending documents using Microsoft Office (Word, Excel, PowerPoint).
5. Experience navigating in a Windows environment.

Preferred Qualifications:

1. Undergraduate degree.
2. Experience with State Medicaid Managed Care.
3. Pre-authorization experience.
4. Utilization Management and Case Management experience.
5. Experience in Medicare utilization management.

*All remote employees must 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 and various factors including location, education, experience, and certifications. We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contributions. Benefits are subject to eligibility requirements.

Our mission is to help people live healthier lives and improve the health system for everyone. We are committed to addressing health disparities and promoting equitable care, especially for marginalized groups and those with lower incomes.

UnitedHealth Group is an Equal Employment Opportunity employer. Qualified applicants will receive consideration regardless of race, gender, sexuality, age, disability, or protected veteran status, among other characteristics.

We are a drug-free workplace. Candidates must pass a drug test before employment begins.