Utilization Management Nurse RN - Remote

Optum; Grants Pass (OR); Remote; USD 59,000 - 117,000; Full time

Job summary

Join Optum as a Utilization Management Nurse and play a pivotal role in enhancing healthcare delivery. This position involves assessing member needs, performing prior authorization reviews, and making impactful decisions that improve health outcomes. With remote flexibility and opportunities for growth, you'll be recognized for your contributions while working in a supportive environment that values your skills.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Qualifications

• Active RN license in state of residency.
• 3+ years of Managed Care and/or Clinical experience.
• Weekend availability and must work Pacific Time Zone hours.

Responsibilities

• Conduct utilization management and prior authorization reviews.
• Determine medical appropriateness of care levels.
• Identify solutions for non-standard requests.

Skills

Basic computer skills

Managed Care experience

Clinical experience

Education

Unrestrictive RN license

Tools

MS Outlook

MS Word

MS Excel

Job description

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.

Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You'll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact?

Must be available to work on the weekend, Saturday and Sunday as part of a 5 day work week schedule.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must work Pacific Time Zone

Primary Responsibilities:

• Positions in this function require unrestricted compact RN licensure


• Function is responsible for utilization management which includes Prior Authorization Review of skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospital


• Determines medical appropriateness of level of care following evaluation of medical guidelines and benefit determination


• Generally, work is self-directed and not prescribed


• Works with less structured, more complex issues


• Identify solutions to non-standard requests and problems


• Translate concepts into practice


• Act as a resource for others; provide explanations and information on difficult issues

It feels great to have autonomy, and there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact our members. And at the same time, you'll be challenged by leveraging technologies and resources in a rapidly changing, production-driven environment.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Active, unrestrictive RN license in state of residency or Compact RN License if residence is in a Compact State


• 3+ years of Managed Care and/or Clinical experience


• Proven basic computer skills with MS Outlook, Word and Excel


• Weekend availability


• Must Work Pacific Time Zone Hours

Preferred Qualifications:

• Multi-Specialty experience


• Utilization Management experience


• Case Management experience


• Multiple EMR experience


• Knowledge of Milliman, Interqual Criteria

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.