Utilization Management Nurse RN - Remote - FL - 2283340

UnitedHealth Group; Orlando (FL); Remote; Confidential; Full time

Job summary

Join a leading healthcare company dedicated to improving health outcomes. As an RN specializing in Utilization Management, you will play a pivotal role in patient care by overseeing authorizations and compliance within Medicaid. This position offers flexibility, significant responsibilities, and rewards based on performance, ensuring an impactful career in healthcare.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Equity stock purchase

Qualifications

• 3+ years of Managed Care and/ or Clinical experience.
• Experience with Medicaid Utilization Management preferred.
• 3+ years Medicaid Utilization Management experience required.

Responsibilities

• Perform utilization management and concurrent review.
• Coach, provide feedback and act as a resource for others.
• Document rationale for UM decisions and ensure accurate documentation.

Skills

Clinical experience

Utilization Management

Communication

Education

Unrestricted RN license

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

If you are located in the state of FL, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Perform utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management)
• Oversee private duty nursing authorization reviews, medical complaints, and behavioral staffing
• Identify solutions to non-standard requests and problems
• Work with minimal guidance; seeks guidance on only the most complex tasks
• Translating concepts into practice
• Provide explanations and information to others on difficult issues
• Coach, provide feedback and guide others
• Act as a resource for others with less experience
• Critical analysis of case manager UM submission with review of supporting tools
• Communicationand collaboration with Medical Director
• Case preparationand presentation for Medical Director review
• Documentation in supportive rationale for UM decision
• Timelyand accurate documentation in database of UM decision

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:

• Unrestricted RN license required in state of residence
• 3+ years of Managed Care and / or Clinical experience preferably working within Medicaid and Utilization Management
• 3+ years of Medicaid Utilization Management experience
• 2+ years of Microsoft experience (Word, Excel, PowerPoint)

Preferred Qualifications:

• Florida State Medicaid Managed Care experience
• Pre-authorization experience
• Case Management experience

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

The hourly range for this role is $28.61 to $56.06 per hour 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.