Remote Utilization Management Nurse

University of Minnesota School of Nursing; Sacramento, Northern (CA, KY); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient and effective health services delivery across care settings. You will assess member needs, determine medical appropriateness, and support clinical decisions to help members live healthier lives.

This role offers remote work with time-zone requirements in Pacific or Mountain regions. Ideal candidates hold a compact RN license, 3+ years in Managed Care or clinical settings, and prior utilization management experience.

Qualifications

• Compact RN license required.
• 3+ years of Managed Care and/or clinical experience.
• Prior Utilization Management experience (not case management).
• Proven basic computer skills with MS Outlook, Word and Excel.

Responsibilities

• Perform utilization management including Prior Authorization in skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospital.
• Determine medical appropriateness of level of care following evaluation of medical guidelines and benefit determination.
• Generally, work is self-directed and not prescribed; handle less structured, more complex issues.
• Identify solutions to non-standard requests and problems; translate concepts into practice.
• Act as a resource for others; provide explanations on difficult issues.

Skills

Utilization Management

Managed Care

RN licensure

Strong computer skills

Tools

MS Outlook

MS Word

MS Excel

Job description

UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient and effective health services delivery across care settings. You will assess member needs, determine medical appropriateness, and support clinical decisions to help members live healthier lives.

This role offers remote work with time-zone requirements in Pacific or Mountain regions. Ideal candidates hold a compact RN license, 3+ years in Managed Care or clinical settings, and prior utilization management experience.