About the position
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 work Arizona time 8am-5pm PST/MST depending on the time of year. 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 enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Responsibilities
- Perform reviews of current inpatient services
- Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
- Work 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
Requirements
- Unrestricted RN license in state of residence
- Compact RN License
- 3+ years of managed care and/or clinical experience
- Willing or ability to work 8am-5pm Arizona Time Zone
- Proven basic computer skills with MS Outlook, Word and Excel
Nice-to-haves
- Certified Case Manager (CCM)
- Pre-authorization experience
- Multi-specialty experience
- Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance
- Utilization management experience
- Case management experience
- Knowledge of Milliman criteria
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
