UnitedHealth Group

UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of

Utilization Management Nurse

Location

United States

Posted

4 days ago

Salary

$60.2K - $107.4K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Utilization Management Nurse

UnitedHealth Group

Role Description The Utilization Review Nurse, RN is responsible for providing clinically efficient and effective Inpatient utilization management. Key responsibilities include: - Reviewing inpatient criteria for acute hospital admissions and concurrent review and/or prior authorization requests. - Following evidence-based clinical guidelines, medical necessity criteria, and health plan guidelines. - Assuring that the patient receives high-quality, cost-effective care. - Preparing cases that do not meet medical necessity guidelines for review with the Medical Director. - Working hours are 8am-5pm in PST or MST, including one weekend day after the training period. - Training for the first 3-6 months will be Monday-Friday 8am-5pm PST. - Flexibility to work remotely from anywhere within the U.S. Qualifications - Current unrestricted Registered Nurse (RN) license in state of residence. - 3+ years of clinical nursing experience in acute care hospital or LTAC setting. - 1+ years of Utilization Management experience in hospital or insurance setting. - Experience applying Medicare and/or Medicaid guidelines. - Experience with Milliman (MCG) or InterQual guidelines. - Experience researching and preparing clinical information for case review with Physician Leadership. - Experience providing accurate and timely documentation of clinical review. - Experience employing analytical skills for quality case management and utilization review. - Experience using various computer software applications, including Microsoft Word and Excel. - Ability to work Monday-Friday 8am-5pm in Pacific or Mountain Time Zone. Requirements - Inpatient Utilization Management experience. - Utilization Management experience for insurance or managed care organization. - Prior Authorization experience. - Primary residence in Pacific Time Zone or Mountain Time Zone. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (subject to eligibility requirements). - Salary range from $60,200 to $107,400 annually based on full-time employment.

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