Utilization Management Nurse RN - Telecommute in Pacific Standard Time anywhere in US
Location: Las Vegas, Nevada
Internal Number: 111996732
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. 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 you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
If you are able to work M - F Pacific Time Zone hours and weekend rotations, you will have the flexibility to telecommute* as you take on some tough challenges.
Perform utilization management, utilization review, or concurrent review (telephonic inpatient care management)
Perform prospective and/or retrospective review utilizing criteria which can include: InterQual, CMS Guidelines, Commercial Health plan, guidelines and/or State mandates
Conduct electronic concurrent review to determine medical/behavioral appropriateness of inpatient care/bed days
Discuss requests with treating physicians and other healthcare professionals to better understand plan of care
Identify and evaluate delays in care
Confirm and monitor the progress of that plan
Gather clinical information to assess and expedite care needs following company policies
Maintain appropriate documentation within operating platform
Consult with the Medical Director as needed to troubleshoot difficult or complex cases and if medical necessity criteria is not met
Participate in telephonic (WebEx) staff meetings and on-line learning
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.
Active, unrestricted RN license in the State of California
2+ years of experience in an acute care setting
Proficient level of experience in Microsoft Office applications (Word, Excel, Outlook, SharePoint) and the ability to navigate multiple screens
Proficient typing skills
Ability to work Monday - Friday between the hours of 8am - 5pm PST and some weekends on a rotating basis
Reside in a location that can receive a UnitedHealth Group approved high speed Internet connection or can leverage existing high-speed Internet service
1+ year of experience in utilization management (on-site or telephonic inpatient care management)
Managed care experience (Prior Authorization, Utilization Management)
Knowledge of MCG, InterQual, Medicaid and Medicare/Commercial criteria
Understanding of DME, OP/IP, SNF Prior Authorization
Ability to function in a high volume, fast paced environment
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Nevada Residents Only: The salary range for Nevada residents is $60,000 to $106,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.