Remote Utilization Management RN - Florida/Medicaid

ANA-Ohio; Town of Florida, Northern (NY, KY); Hybrid; USD 40,000 - 72,000; Full time

Job summary

UnitedHealthcare is transforming care by removing barriers and improving access to quality services. This role focuses on utilization management and determining medical necessity for in-home LTC services, with collaboration across teams and Medical Director support.

Florida-based candidates with an unrestricted RN license and relevant managed care experience are preferred. Proficiency in Microsoft Office and Windows is required; CCM and undergraduate degrees are a plus for advancement.

Qualifications

• Unrestricted RN license in Florida is required.
• Managed Care or Clinical experience preferred, especially Medicaid/utilization management.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint) and Windows navigation.

Responsibilities

• Perform UM/UR or concurrent review.
• Determine medical necessity for in-home LTC services.
• Identify solutions for non-standard requests and problems.
• Work with minimal guidance; seek guidance on complex tasks.

Skills

Unrestricted RN license

Managed Care experience

Clinical experience

Documentation & Office tools

Windows navigation

Education

Undergraduate degree

Certified Case Manager (CCM)

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

ICUE

Job description

UnitedHealthcare is transforming care by removing barriers and improving access to quality services. This role focuses on utilization management and determining medical necessity for in-home LTC services, with collaboration across teams and Medical Director support.

Florida-based candidates with an unrestricted RN license and relevant managed care experience are preferred. Proficiency in Microsoft Office and Windows is required; CCM and undergraduate degrees are a plus for advancement.