Remote Utilization Management RN — Drive Care Efficiency

RXinsider LTD.; Sacramento, Northern (CA, KY); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

401k contribution

Job summary

UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient administration of health services. You will assess member needs, determine medical necessity, and guide care levels across facilities such as SNFs and inpatient rehab.

The role offers telecommuting from Pacific or Mountain time zones with autonomy and responsibilities affecting patient care. Requirements include RN license, 3+ years in managed care or clinical settings, and experience in utilization management.

Qualifications

• Compact RN license required.
• 3+ years of managed care or clinical experience.
• Prior utilization management experience (not case management).
• Proficient with MS Outlook, Word, and Excel.
• Prior-authorization experience preferred.
• Multi-specialty experience preferred.
• Experience in SNF or inpatient rehab preferred.
• EMR experience: Epic, Cerner, TMC, Meditech or Care Advance.
• Knowledge of Milliman Criteria preferred.
• Remote workers must adhere to telecommuter policy.

Responsibilities

• Unrestricted compact RN licensure is required.
• Handle utilization management including prior authorization reviews for SNF, inpatient rehab, and LTAC.
• Assess and determine medical appropriateness of level of care using guidelines and benefits.
• Work self-directed with minimal supervision.
• Tackle complex, non-standard issues.
• Identify solutions to non-standard requests and problems.
• Translate concepts into practical applications.
• Serve as a resource with explanations on difficult issues.

Skills

Managed Care Experience

Utilization Management

Healthcare IT

Education

RN License

Tools

Epic

Cerner

TMC

Meditech

CareAdvance

Job description

UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient administration of health services. You will assess member needs, determine medical necessity, and guide care levels across facilities such as SNFs and inpatient rehab.

The role offers telecommuting from Pacific or Mountain time zones with autonomy and responsibilities affecting patient care. Requirements include RN license, 3+ years in managed care or clinical settings, and experience in utilization management.