Utilization Management Nurse - Remote in NM

UnitedHealth Group; New Mexico; Remote; USD 60,000 - 107,000; Full time

Job summary

UnitedHealth Group is seeking an Utilization Management Nurse in Albuquerque, NM. This full-time, day-shift role serves as the Health Plan subject matter expert for Utilization Management, communicating clinical findings to medical professionals and members.

The position requires NM residency, an active RN license, and 3+ years of clinical experience with at least 1 year in UM. Strong MS Office skills and experience in HCBS LTSS UM Determination are preferred.

Qualifications

• 3+ years of clinical experience.
• 1+ years of Utilization Management experience.
• 1+ year of experience with MS Office (Word, Excel, Outlook).
• 1+ year of experience in HCBS LTSS Care Coordination and LTSS UM Determination.
• Experience in Managed Care requirements.

Responsibilities

• Conduct Initial and Concurrent Utilization Reviews for LTSS.
• Review chart/clinical information and identify appropriate courses of care.
• Determine medical appropriateness of inpatient and outpatient services.
• Anticipate customer needs and develop proactive solutions.
• Solve complex problems and develop innovative solutions.
• Review work performed by others and recommend improvements.
• Authorize deviations from standards.
• Provide explanations on complex issues to others.
• Communicate using appropriate clinical terminology with medical professionals.
• Advocate for appropriate decisions regarding patient care and service coverage.

Skills

Clinical experience

Utilization Management

MS Office

Education

RN license (New Mexico)

Tools

MS Office

Job description

The Utilization Management Nurse will serve as the Health Plan subject matter expert for Utilization Management, addressing complex issues and communicating clinical findings to medical professionals and members. This remote position is ideal for those located in New Mexico who are ready to tackle challenging healthcare scenarios.

Highlights

• Pay: $60,200 - $107,400/year
• Location: Albuquerque, NM
• Department/Unit: Utilization Management
• Schedule: Full Time, Day shift
• Residency: Must reside in New Mexico

What You'll Do

• Conduct Initial and Concurrent Utilization Reviews for LTSS.
• Review chart/clinical information and identify appropriate courses of care.
• Determine medical appropriateness of inpatient and outpatient services.
• Anticipate customer needs and develop proactive solutions.
• Solve complex problems and develop innovative solutions.
• Review work performed by others and recommend improvements.
• Authorize deviations from standards.
• Provide explanations on complex issues to others.
• Communicate using appropriate clinical terminology with medical professionals.
• Advocate for appropriate decisions regarding patient care and service coverage.

Requirements

• Education: Current, unrestricted independent licensure as a New Mexico Registered Nurse
• Experience: 3+ years of clinical experience
• 1+ years of Utilization Management experience
• 1+ years of experience with MS Office (Word, Excel, Outlook)
• 1+ year of experience in HCBS LTSS Care Coordination and LTSS UM Determination
• Experience in Managed Care

Licenses & Certifications

• Current RN License in New Mexico required

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on simplifying the healthcare experience and creating healthier communities through innovative solutions and technology.