Remote Inpatient Utilization RN - Care Coordination

Optum; United States; Remote; USD 40,000 - 72,000; Full time

Benefits offered by this job

Comprehensive benefits

401k plan

Remote work flexibility

Job summary

Optum is seeking a Utilization Review Nurse, RN, to lead inpatient utilization management, applying evidence-based guidelines and criteria to determine medical necessity for admissions and authorizations.

The role requires 3+ years of clinical nursing and 1+ year in Utilization Management, with ability to work PST/MST hours or remotely in the U.S. Compensation ranges from $29.00–$52.00 hourly.

Qualifications

• Current unrestricted Registered Nurse (RN) license in state of residence.
• Ability to obtain RN license in California within 90 days of hire.
• 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.
• Experience researching and preparing clinical information for case review with Physician Leadership.
• Experience providing accurate documentation of clinical review in care management systems.
• Experience using MS Word and Excel.

Responsibilities

• Maintains clinical expertise and knowledge of nursing and medical progress.
• Performs clinical reviews for appropriate utilization of medical services.
• Authorizes healthcare services in compliance with guidelines.
• Documents clinical reviews in care management system with rationale.
• Uses care management system to track utilization, variances and outcomes.
• Prepares clinical information for case review with Physician Leadership.
• Identifies members for care coordination programs and collaborates with Medical Management team.
• Completes Interrater Reliability Testing to ensure consistent application of criteria.
• Meets timeliness standards for decision, notification, and prior authorization.
• Acts as an advocate for providers and patients.
• Maintains confidentiality of patient and company information.

Skills

RN license

Utilization Management

Medicare/Medicaid guidelines

Milliman/MCG guidelines

Documentation

Analytical skills

Microsoft Word

Microsoft Excel

Care management system

Time zone flexibility

Tools

Care management system

Job description

Optum is seeking a Utilization Review Nurse, RN, to lead inpatient utilization management, applying evidence-based guidelines and criteria to determine medical necessity for admissions and authorizations.

The role requires 3+ years of clinical nursing and 1+ year in Utilization Management, with ability to work PST/MST hours or remotely in the U.S. Compensation ranges from $29.00–$52.00 hourly.