Remote Utilization Management RN: Shape Care Decisions

Registered Nurse; Sacramento, Northern (CA, KY); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Benefits package

Incentives & recognition

Equity stock purchase

401k plan

Job summary

UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient and effective administration of health services. You will assess member needs, determine medical necessity of level of care, and guide care decisions in a remote setting.

Baseline requirements include Compact RN license and 3+ years in managed care or clinical settings, with prior utilization management experience. Experience with MS Office and multiple EMR systems is preferred.

Qualifications

• Compact RN license required.
• 3+ years of managed care and/or clinical experience.
• Prior utilization management experience (not case management).
• Proficient with MS Outlook, Word and Excel.

Responsibilities

• Prior Authorization Review for SNF, inpatient rehab and LTAC.
• Assess and determine medical appropriateness of level of care.
• Work in a self-directed role handling complex issues and non-standard requests.
• Translate concepts into practice and act as a resource for others.

Skills

Managed Care

Utilization Management

MS Office

Prior-authorization experience

Multi-specialty experience

SNF/IRF experience

Milliman Criteria

EMR systems

Education

Compact RN License

Tools

Epic

Cerner

TMC

Meditech

Care Advance

Job description

UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient and effective administration of health services. You will assess member needs, determine medical necessity of level of care, and guide care decisions in a remote setting.

Baseline requirements include Compact RN license and 3+ years in managed care or clinical settings, with prior utilization management experience. Experience with MS Office and multiple EMR systems is preferred.