Remote Utilization Management Nurse — Drive Care Decisions

UnitedHealth Group; United States; Remote; USD 60,000 - 107,000; Full time

Job summary

UnitedHealth Group's UnitedHealthcare team is seeking a remote Utilization Management Nurse in New Mexico. You will act as the health plan expert for utilization management, communicating clinical findings to physicians and members and supporting decisions with clear rationale.

This role requires NM RN licensure, 3+ years of clinical experience, and UM-specific background. You will review care plans, determine medical necessity, and collaborate with the Medical Director, with travel up to 10% as

Qualifications

• Current, unrestricted NM RN licensure.
• 3+ years of clinical experience.
• 1+ years of Utilization Management experience.
• 1+ year of HCBS LTSS Care Coordination and LTSS UM Determination.
• Experience in Managed Care.
• Currently reside in New Mexico.
• Valid driver’s license and reliable transportation.
• Ability to travel locally up to 10% of the time.
• Ability to adhere to a Monday - Friday MST work schedule.

Responsibilities

• Function is responsible for utilization management which includes Initial and Concurrent Utilization Reviews for LTSS.
• Leverage experience and understanding of disease pathology to review chart/clinical information and determine appropriate course of care.
• Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines.
• Anticipates customer needs and proactively develops solutions to meet them.
• Solves complex problems and develops innovative solutions.
• Reviews work performed by others and provides recommendations for improvement.
• Authorizes deviations from standards.
• Provides explanations and information to others on the most complex issues.

Skills

Clinical experience

Utilization Management

MS Office

LTSS Care Coordination

Managed Care

Travel up to 10%

Reliable transportation

Mon-Fri MST schedule

Education

RN licensure (New Mexico)

Tools

MS Office (Word, Excel, Outlook)

Job description

UnitedHealth Group's UnitedHealthcare team is seeking a remote Utilization Management Nurse in New Mexico. You will act as the health plan expert for utilization management, communicating clinical findings to physicians and members and supporting decisions with clear rationale.

This role requires NM RN licensure, 3+ years of clinical experience, and UM-specific background. You will review care plans, determine medical necessity, and collaborate with the Medical Director, with travel up to 10% as