Utilization Management RN - Optum West - Remote in PST or MST

RXinsider LTD.; Sacramento, Northern (CA, KY); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

401k contribution

Job summary

UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient administration of health services. You will assess member needs, determine medical necessity, and guide care levels across facilities such as SNFs and inpatient rehab.

The role offers telecommuting from Pacific or Mountain time zones with autonomy and responsibilities affecting patient care. Requirements include RN license, 3+ years in managed care or clinical settings, and experience in utilization management.

Qualifications

• Compact RN license required.
• 3+ years of managed care or clinical experience.
• Prior utilization management experience (not case management).
• Proficient with MS Outlook, Word, and Excel.
• Prior-authorization experience preferred.
• Multi-specialty experience preferred.
• Experience in SNF or inpatient rehab preferred.
• EMR experience: Epic, Cerner, TMC, Meditech or Care Advance.
• Knowledge of Milliman Criteria preferred.
• Remote workers must adhere to telecommuter policy.

Responsibilities

• Unrestricted compact RN licensure is required.
• Handle utilization management including prior authorization reviews for SNF, inpatient rehab, and LTAC.
• Assess and determine medical appropriateness of level of care using guidelines and benefits.
• Work self-directed with minimal supervision.
• Tackle complex, non-standard issues.
• Identify solutions to non-standard requests and problems.
• Translate concepts into practical applications.
• Serve as a resource with explanations on difficult issues.

Skills

Managed Care Experience

Utilization Management

Healthcare IT

Education

RN License

Tools

Epic

Cerner

TMC

Meditech

CareAdvance

Job description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. 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?

• Although this position is remote, applicants must be located in Pacific or Mountain Time Zones***

If you are located in Pacific or Mountain time zones, you will have the flexibility to work remotely as you take on some tough challenges.

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

• Compact RN License
• 3+ years of Managed Care and/or clinical experience
• Prior Utilization Management experience (not case management)
• Proven basic computer skills with MS Outlook, Word and Excel

Preferred Qualifications

• Prior-authorization experience
• Multi-specialty experience
• Experience in a skilled nursing facility or inpatient rehabilitation facility
• Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance
• Knowledge of Milliman Criteria
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

OptumCare 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.

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