Remote RN - Inpatient Utilization Management

ISHE; Sacramento (CA); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Telecommuter Policy

Benefits package

Equity stock purchase

401k contribution

Job summary

Optum, part of UnitedHealth Group, is seeking a Utilization Review Nurse, RN, to perform inpatient utilization management. The role requires clinical expertise, documentation of reviews, and adherence to medical necessity criteria.

Remote work is available for PST/MST while weekend shifts are required in some time zones. Applicants should have 3+ years in acute care and 1+ year in utilization management, with Medicare/Medicaid guideline experience and InterQual/Milliman familiarity.

Qualifications

• Active RN license in home state
• California RN license required or able to obtain within 90 days
• 3+ years of clinical nursing in acute care or LTAC
• 1+ year of Utilization Management experience
• Experience applying Medicare/Medicaid guidelines
• Experience with InterQual or Milliman guidelines
• Experience documenting clinical reviews in care management systems
• Strong analytical skills for quality case management and utilization review
• Proficiency in MS Word and Excel

Responsibilities

• Maintain clinical expertise and apply current knowledge to care coordination processes
• Perform clinical reviews for appropriate use of medical services using medical necessity criteria
• Authorize healthcare services per contracts, plan guidelines, and medical necessity criteria
• Document clinical reviews with rationale in the care management system
• Track utilization, variances, and outcomes using care management tools
• Prepare clinical information for case review with Physician Leadership
• Collaborate with care management to coordinate patient needs across the care continuum
• Ensure timely completion of decisions, notifications, and prior authorizations
• Maintain confidentiality of all patient and company information
• Fulfill other duties to support department goals

Skills

RN license

CA RN license

Acute care nursing

Utilization management

Medicare/Medicaid guidelines

InterQual/Milliman guidelines

Care management documentation

Analytical skills

MS Word & Excel

Tools

Microsoft Word

Excel

Job description

Optum, part of UnitedHealth Group, is seeking a Utilization Review Nurse, RN, to perform inpatient utilization management. The role requires clinical expertise, documentation of reviews, and adherence to medical necessity criteria.

Remote work is available for PST/MST while weekend shifts are required in some time zones. Applicants should have 3+ years in acute care and 1+ year in utilization management, with Medicare/Medicaid guideline experience and InterQual/Milliman familiarity.