Remote Inpatient Utilization Management Nurse, RN

IntelliResume; California (MO); Remote; USD 40,000 - 72,000; Full time

Job summary

UnitedHealth Group is seeking an Inpatient Utilization Management Nurse, RN for a fully remote role serving the Sacramento area. The position requires 3+ years in acute care and 1+ year in utilization management, with certification in RN licensure and ability to obtain California licensure within 90 days.

The role focuses on clinical reviews, authorization decisions, and care coordination. The ideal candidate will stay current with nursing and medical advances and meet strict timelines for

Qualifications

• 3+ years of clinical nursing experience in acute care hospital or LTAC setting.
• 1+ years of Utilization Management experience in hospital or insurance setting.
• Experience applying Medicare and/or Medicaid guidelines.
• Experience with Milliman (MCG) or InterQual guidelines.

Responsibilities

• Maintain clinical expertise and knowledge of nursing and medical progress.
• Perform clinical review for appropriate utilization of medical services.
• Authorize healthcare services in compliance with contractual agreements and guidelines.
• Document clinical reviews in care management system with accurate and timely documentation.
• Utilize care management system to track and analyze utilization and patient outcomes.
• Research and prepare clinical information for case review with Physician Leadership.
• Identify members appropriate for care coordination programs and collaborate with Medical Management.
• Meet timeliness standards for decision, notification, and prior authorization activities.

Skills

Clinical nursing

Utilization Management

Medicare/Medicaid guidelines

Education

Registered Nurse (RN) license

Tools

Milliman (MCG)

InterQual guidelines

Job description

UnitedHealth Group is seeking an Inpatient Utilization Management Nurse, RN for a fully remote role serving the Sacramento area. The position requires 3+ years in acute care and 1+ year in utilization management, with certification in RN licensure and ability to obtain California licensure within 90 days.

The role focuses on clinical reviews, authorization decisions, and care coordination. The ideal candidate will stay current with nursing and medical advances and meet strict timelines for