RN, Utilization Management Nurse - Remote

Optum; Irvine (CA); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading healthcare organization seeks an RN for Utilization Management. This remote role involves reviewing patient referrals, ensuring compliance with regulations, and maintaining communication with stakeholders. Ideal candidates will have a California RN license and experience in prior authorization. Join us to make a significant impact on health outcomes.

Benefits

Comprehensive Benefits

Incentive Programs

Stock Options

401k Contributions

Qualifications

• Ensuring integrity of adverse determination processes.
• Maintaining effective communication with providers and patients.

Responsibilities

• Reviewing patient referrals and communicating authorizations or denials.
• Implementing policies and maintaining documentation.

Skills

Communication

Decision-Making

Education

Accredited Nursing Program

California RN License

Job description

Join to apply for the RN, Utilization Management Nurse - Remote role at Optum.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Responsibilities include:

• Ensuring the integrity of adverse determination processes and accuracy of clinical decision-making related to criteria application and regulatory requirements.
• Performing all functions of an UM Nurse, including reviewing patient referrals, communicating authorization or denial of services, and maintaining accurate documentation.
• Implementing current policies, procedures, and regulatory turnaround times.
• Utilizing reports to understand cost implications of utilization management decisions.
• Maintaining effective communication with providers, patients, and health plans.
• Meeting productivity standards and completing educational requirements.
• Protecting patient information according to HIPAA standards.

Qualifications:

• Graduation from an accredited Nursing program.
• Current California RN license.

Preferred:

• 2+ years of Prior Authorization UM experience.

This role offers a flexible remote work environment for those with an active CA RN license and ability to work PST hours. The hourly pay ranges from $28.61 to $56.06, based on experience and other factors. Benefits include comprehensive packages, incentive programs, stock options, and 401k contributions.

At UnitedHealth Group, we are committed to diversity, equity, and inclusion, striving to mitigate health disparities and promote equitable care. We are an Equal Employment Opportunity employer and a drug-free workplace.