Utilization Management Nurse - Remote

UnitedHealth Group • Eden Prairie, MN • 1h ago

Requisition number: 2358175

Job category: Nursing

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.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Perform initial and concurrent review of inpatient cases applying criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination

Discuss cases with facility healthcare professionals to obtain plans-of-care

Collaborate with UnitedHealthcare Medical Directors on performing utilization management

Participation in the Clinical Services team to improve the progression of care to the most appropriate level

Consult with the Medical Director as needed for complex cases and make appropriate referrals to sister segments

Apply clinical expertise when discussing case with internal and external Case Managers and Physicians

Identify delays in care or services and manage with MD

Follow all Standard Operating Procedures in end-to-end management of cases

Obtain clinical information to assess and expedite alternate levels of care

Facilitate timely and appropriate care and effective discharge planning

Participate in team meetings, education discussions and related activities

Maintain compliance with Federal, State and accreditation organizations

Identify opportunities for improved communication or processes

Participate in telephonic staff meetings

Plan for MCG Certification

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:

A current, unrestricted RN license in resident state

3+ years of total experience including recent clinical experience in an inpatient/acute setting

Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities

Experience performing discharge planning

Experience in Utilization review and/or Utilization management

Prove solid computer skills

Preferred Qualifications:

Bachelor's degree

Certification in Case Management or willingness to obtain

2+ years of case management

Experience with MCG Guidelines or InterQual

Proven ability to work independently

Demonstrates effective verbal and written communication skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. 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.

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.

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.

Similar Jobs

Technical Product Lead, Commercial Banking

Deloitte • Minneapolis, MN • 2h ago

Hospital & Medical

Position Summary Join our AI & Engineering team in transforming technology platforms, driving innovation, and helping make a significant impact on our clients' success. You'll work alongside talented professionals re...

2h ago

Go to Apply

Healthcare Support Specialist

U.S. Bank • Minneapolis, MN • 2h ago

Hospital & Medical

At U.S. Bank, we're on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions and enabling the communities we support to grow and succeed. We believe it tak...

2h ago

Go to Apply

Outpatient Therapist - Hybrid or Onsite

UnitedHealth Group • Mendota Heights, MN • 3h ago

Hospital & Medical

Requisition number: 2358060 Job category: Behavioral CARE Counseling , part of the Optum family of businesses, is seeking Licensed Outpatient Therapists to join our teams throughout the Twin Cities, MN. As a member of th...

3h ago

Go to Apply

Outpatient Therapist - Hybrid or Onsite

UnitedHealth Group • Edina, MN • 3h ago

Hospital & Medical

3h ago

Go to Apply

Outpatient Therapist - Hybrid or Onsite

UnitedHealth Group • Saint Louis Park, MN • 3h ago

Hospital & Medical

3h ago

Go to Apply

Outpatient Therapist - Hybrid or Onsite

UnitedHealth Group • Plymouth, MN • 3h ago

Hospital & Medical

3h ago

Go to Apply

Outpatient Therapist - Hybrid or Onsite

UnitedHealth Group • Minneapolis, MN • 3h ago

Hospital & Medical

3h ago

Go to Apply

Outpatient Therapist - Hybrid or Onsite

UnitedHealth Group • Maple Grove, MN • 3h ago

Hospital & Medical

3h ago

Go to Apply

Occupational Therapist PRN

Cassia • Plymouth, MN • 3h ago

Hospital & Medical

Pro Rehab, an established Rehab company with over 35 years of successful business is hiring an Occupational Therapist. We are looking for an Occupational Therapist to join the team at Allina Health Restorative Suites, a...

3h ago

Go to Apply

Sterile Processing Clerk - West Health Surgery Center

Surgery Care Affiliates • Plymouth, MN • 19h ago

Hospital & Medical

Overview At SCA Health, we believe health care is about people - the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team...

19h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)