RN Care Management(Remote)

Utilization Management Nurse

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Utilization Management Nurse will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department's/company's guidance. The nurse will complete their case within the time expectations while providing high quality reviews. The Utilization Management Nurse will perform their job functions, adhering to both Optum and OPAS policies and procedures, which include but are not limited to the following:

Schedule: Monday - Friday (40 Hours a Week) Flexible start times with the ability to support evening, weekend and holiday shifts.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Follows directive of composing appeal letters to include appropriate data extraction, construction of well-written appeals letters with proper grammar, utilization of appeal tools including pre-constructed templates, inclusion of appropriate medical literature references, and use of national criteria guidelines. Adheres to company policies and procedures as well as policies, procedures, and laws

Understands and complies with HIPAA confidentiality requirements

Support and promote OPAS, Optum, and the enterprise goals and mission

Build relationships across Optum, OPAS, OGA and our clients

Collaborate with peers to assure continuity of communication and execution of deliverables as needed

Adheres to quality and productivity expectations

Participate in and contribute to meetings as appropriate

Maintains organization on the team and ensures everyone conducts themselves professionally

Remains up to date with all learning modules, competencies, and state required licenses

Performs other related duties, tasks, and processes as required by leadership

Ability to establish priorities, be self-motivated, work independently, and follow instructions with supervision and structure

Positive attitude and the ability to function as a collaborative team member

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:

• Associate's degree
• Unrestricted Registered Nurse license in your state of residence
• 3+ years of bedside nursing experience in ED/telemetry/ICU/CCU
• Advanced level of proficiency with Microsoft applications and software, internet navigation and utilization
• Ability to type 45 wpm

Preferred Qualifications:

Working knowledge of InterQual and MCG

Prior experience with utilization management

Working knowledge of Word

Strong, effective verbal and written communication skills

Pay 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). The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

UnitedHealth Group 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Reliant Medical Group