Remote Inpatient Utilization RN — Care Coordination

UnitedHealth Group; Sacramento (CA); Remote; Confidential; Full time

Benefits offered by this job

Telecommuter policy

Comprehensive benefits package

401k and stock purchase options

Job summary

UnitedHealth Group is seeking a Utilization Review Nurse, RN to perform inpatient utilization management in California. The role involves reviewing inpatient criteria, preauthorizations, and ensuring medical necessity while applying evidence-based guidelines.

In addition to clinical duties, you will document decisions and collaborate with Medical Directors for complex cases. The position may offer remote work options and requires working a Monday–Friday schedule with weekend rotation.

Qualifications

• Current unrestricted RN license in state of residence
• Ability to obtain California license within 90 days of hire
• 3+ years of clinical nursing in acute care hospital or LTAC
• 1+ year of Utilization Management experience in hospital or insurance setting
• Experience applying Medicare and/or Medicaid guidelines
• Experience with Milliman (MCG) or InterQual guidelines
• Experience documenting clinical reviews in care management systems

Responsibilities

• Maintains clinical expertise and knowledge of nursing and medical progress and applies it to clinical review and care coordination
• Performs clinical review for appropriate utilization of medical services using medical necessity criteria
• Authorizes healthcare services in compliance with contracts and health plan guidelines
• Documents clinical reviews and provides rationale in care management system
• Tracks utilization, variances, trends, patient outcomes and quality indicators
• Prepares clinical information for case review with Physician Leadership for patient treatment and care planning
• Collaborates with Medical Management team for care coordination of member needs

Skills

RN license

Utilization Management

Medicare/Medicaid guidelines

MCG/InterQual guidelines

Microsoft Word & Excel

Time zone availability (Pacific/MST)

Tools

Microsoft Word

Excel

Job description

UnitedHealth Group is seeking a Utilization Review Nurse, RN to perform inpatient utilization management in California. The role involves reviewing inpatient criteria, preauthorizations, and ensuring medical necessity while applying evidence-based guidelines.

In addition to clinical duties, you will document decisions and collaborate with Medical Directors for complex cases. The position may offer remote work options and requires working a Monday–Friday schedule with weekend rotation.