Utilization Management Nurse

Utilization Management NurseFor 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 licensureFunction is responsible for utilization management which includes Prior Authorization Review of skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospitalDetermines medical appropriateness of level of care following evaluation of medical guidelines and benefit determinationGenerally, work is self-directed and not prescribedWorks with less structured, more complex issuesIdentify solutions to non-standard requests and problemsTranslate concepts into practiceAct as a resource for others; provide explanations and information on difficult issuesIt 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 License3+ years of Managed Care and/or clinical experiencePrior Utilization Management experience (not case management)Proven basic computer skills with MS Outlook, Word and ExcelPreferred Qualifications:Prior-authorization experienceMulti-specialty experienceExperience in a skilled nursing facility or inpatient rehabilitation facilityMultiple EMR experience including Epic, Cerner, TMC, Meditech or Care AdvanceKnowledge of Milliman CriteriaPay 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.