Remote Utilization Management Nurse — New Mexico

UnitedHealthcare; Albuquerque (NM); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare in New Mexico offers a remote Utilization Management Nurse role that supports members and providers while ensuring medical necessity and appropriate care. You will review clinical information, communicate findings, and coordinate with health plan physicians for decisions.

This home-based position requires NM residency, an active NM RN license, 3+ years of clinical experience, and 1+ year UM experience.

Qualifications

• Current, unrestricted NM RN licensure.
• 3+ years of clinical experience.
• 1+ years of Utilization Management experience.
• 1+ year of MS Office (Word, Excel, Outlook).
• Experience in HCBS LTSS Care Coordination and LTSS UM Determination is a plus.
• Experience in Managed Care.
• Residency in New Mexico.
• Valid driver’s license and reliable transportation.
• Willingness to travel up to 10% locally.
• Ability to adhere to a Monday–Friday MST work schedule.

Responsibilities

• Conduct Initial and Concurrent Utilization Reviews for LTSS.
• Review chart/clinical information and determine appropriate course of care.
• Determine medical appropriateness of inpatient/outpatient services.
• Communicate findings and rationale to clinicians and members.

Skills

Clinical experience

Utilization Management

MS Office (Word Excel Outlook)

New Mexico RN licensure

Valid driver’s license

Willingness to travel

Mon-Fri MST schedule

Education

Nursing degree (RN)

Tools

None

Job description

UnitedHealthcare in New Mexico offers a remote Utilization Management Nurse role that supports members and providers while ensuring medical necessity and appropriate care. You will review clinical information, communicate findings, and coordinate with health plan physicians for decisions.

This home-based position requires NM residency, an active NM RN license, 3+ years of clinical experience, and 1+ year UM experience.