UnitedHealth Group-posted 12 months ago
$59,500 - $116,600/Yr
Full-time • Mid Level
Remote • Los Angeles, CA
5,001-10,000 employees
Insurance Carriers and Related Activities

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity 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. If you are have CA RN license and is willing to work in PST, you will have the flexibility to work remotely* as you take on some tough challenges.

  • Perform initial and concurrent review of inpatient cases applying InterQual criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination
  • Discuss cases with facility healthcare professionals to obtain plans-of-care
  • Collaborate with Optum Medical Directors on performing utilization management
  • Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
  • Consult with the Medical Director as needed for complex cases and make appropriate referrals to sister segments
  • Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
  • Identify delays in care or services and manage with MD
  • Follow all Standard Operating Procedures in end to end management of cases
  • Obtain clinical information to assess and expedite alternate levels of care
  • Participate in team meetings, education discussions and related activities
  • Maintain compliance with Federal, State and accreditation organizations
  • Identify opportunities for improved communication or processes
  • Participate in telephonic staff meetings
  • Undergraduate degree or equivalent experience
  • Unrestricted RN license required in state of California
  • 3+ years of Managed Care and/or Clinical experience
  • Must be willing to work 8:00 AM - 5:00 PM PST
  • Certified Case Manager (CCM)
  • Pre-authorization experience
  • Utilization Management experience
  • Case Management experience
  • Knowledge of InterQual guidelines
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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