LTSS Utilization Management RN - Remote - 2284241

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

Job summary

A leading health care company is seeking a Utilization Management RN to perform reviews and manage care for patients. This role offers the flexibility of remote work within Florida and provides opportunities for professional growth. The ideal candidate will hold an unrestricted RN license and have experience in managed care, Medicaid, and Utilization Management. Join a mission-driven team that prioritizes equitable health care and community well-being.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contributions

Qualifications

• 1+ years of managed care and/or clinical experience.
• Unrestricted RN license required in the state of residence.

Responsibilities

• Perform utilization management and review.
• Communicate and collaborate with Medical Director.
• Document supportive rationale for UM decisions.

Skills

Communication

Critical Analysis

Education

Undergraduate degree

Tools

Microsoft Office

Windows

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. 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:

1. Perform utilization management, utilization 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 on only the most complex tasks
5. Translate concepts into practice
6. Provide explanations and information to others on difficult issues
7. Coach, provide feedback, and guide others
8. Act as a resource for others with less experience
9. Critically analyze case manager UM submissions with review of 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 required in the state of residence
2. 1+ years of managed care and/or clinical experience, preferably within Medicaid and Utilization Management
3. 1+ years of Medicaid Utilization Management experience
4. 1+ years of experience creating, editing, saving, and sending documents using Microsoft Office (Word, Excel, PowerPoint)
5. 1+ years of navigating in a Windows environment

Preferred Qualifications:

1. Undergraduate degree
2. State Medicaid Managed Care experience
3. Pre-authorization experience
4. Utilization Management experience
5. Case Management experience
6. Experienced 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. Compensation depends on factors such as local labor markets, education, experience, and certifications. UnitedHealth Group offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contributions (eligibility requirements apply). Regardless of where or when you start your career with us, you'll find a broad array of benefits and incentives.

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. We also focus on reducing our environmental impact.

UnitedHealth Group is an Equal Employment Opportunity employer. Qualified applicants will receive consideration regardless of race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by law.

We are a drug-free workplace. Candidates must pass a drug test prior to employment.