LTSS Utilization Management RN - Remote in FL

Texas Health Institute; Town of Florida, Northern (NY, KY); Hybrid; USD 83,097,000 - 149,001,000; Full time

Benefits offered by this job

Remote-friendly policy

Job summary

UnitedHealth Group is seeking a Registered Nurse in Florida for utilization management roles, including UM decisions for in-home LTC services. Remote work is available for Florida residents, with collaboration across Medical Director and UM teams.

The role requires an unrestricted Florida RN license, Medicaid/Managed Care UM experience, and proficiency with Microsoft Office. CCM and pre-authorization experience are preferred. Competitive hourly compensation is offered.

Qualifications

• Unrestricted RN license in Florida.
• Managed Care and/or Clinical experience in Medicaid UM.
• Proficient in Microsoft Office (Word, Excel, PowerPoint).
• Navigate a Windows environment with ease.

Responsibilities

• Perform utilization management, utilization review, or concurrent review.
• Determine medical necessity for in-home LTC services and support.
• Identify solutions to non-standard requests and problems.
• Work with minimal guidance; seek guidance on only the most complex tasks.
• Translate concepts into practice and provide explanations to others.
• Coach, provide feedback and guide others.
• Act as a resource for less experienced colleagues.
• Conduct critical analysis of UM submissions and supporting tools.
• Collaborate with Medical Director and prepare cases for review.
• Document UM decisions timely and accurately in ICUE and Community Care.

Skills

RN license (FL)

Managed Care experience

Windows navigation

Communication skills

Education

Undergraduate degree

Certified Case Manager (CCM)

Tools

Microsoft Office

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

If you reside in the state of Florida, 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
• 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
• Review and provide documentation in supportive rationale for UM decision
• Timely and accurate documentation in ICUE and Community Care 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 Florida
• Managed Care and / or Clinical experience preferably working within Medicaid and Utilization Management
• Ability to create, edit, save and send documents utilizing Microsoft Office (Word, Excel, PowerPoint)
• Ability to navigate a Windows environment

Preferred Qualifications:

• Undergraduate degree
• Certified Case Manager (CCM)
• State Medicaid Managed Care experience
• Pre-authorization experience
• Utilization Management experience
• Case Management experience
• Medicaid Utilization Management experience
• Experienced in Medicare utilization management

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.