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

UnitedHealth Group•Sacramento, CA

3d•$29 - $52•Remote

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 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. 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.

Requirements

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

Nice To Haves

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

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