Remote Utilization Management RN for HCBS (DC Area)

UnitedHealth Group; Washington (District of Columbia); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Sign-on bonus

Telecommute option

Job summary

UnitedHealth Group is seeking an Utilization Management Registered Nurse in the Washington, DC area to perform pre-service clinical coverage reviews for HCBS and PDN/PCS benefits. This role collaborates with a broad care team and requires a DC RN license and several years of UM experience.

You will coordinate with Medical Directors, AHBS providers, and internal teams to ensure medical necessity and appropriate service delivery, with standard hours and the possibility to telecommute for DC-area

Qualifications

• Unrestricted RN license in the District of Columbia.
• 2+ years of clinical experience in health care settings.
• 2+ years working in a managed care setting.
• 2+ years of utilization management experience.
• Proficient with Word, Excel and Outlook.

Responsibilities

• Handle intake of HCBS authorizations and review requests.
• Review and process HCBS authorizations including budget reviews.
• Assist case management to determine approval and interventions.
• Coordinate with Medical Director for review and clinical criteria application.
• Collaborate with Care Management to assess member needs.
• Support UM meetings and audits as required.
• Maintain professional conduct in all interactions.

Skills

Utilization management

Interdisciplinary collaboration

Microsoft Office Suite

Education

DC RN license

Tools

Microsoft Office

Job description

UnitedHealth Group is seeking an Utilization Management Registered Nurse in the Washington, DC area to perform pre-service clinical coverage reviews for HCBS and PDN/PCS benefits. This role collaborates with a broad care team and requires a DC RN license and several years of UM experience.

You will coordinate with Medical Directors, AHBS providers, and internal teams to ensure medical necessity and appropriate service delivery, with standard hours and the possibility to telecommute for DC-area