Utilization Management Nurse RN - Telecommute - Full-time / Part-time

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. Ready for a new path? Join us and start doing your life's best work.(sm)
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. Primary Responsibilities:

Perform utilization management, utilization review, or concurrent review (on - site or telephonic inpatient care management)
Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
Assess and interpret customer needs and requirements
Identify solutions to non - standard requests and problems
Work with minimal guidance; seeks guidance on only the most complex tasks
Translate concepts into practice
Provide explanations and information to others on difficult issues
Coach, provide feedback, and guide others
Act as a resource for others with less experience

Required Qualifications:

Current, unrestricted RN license in the state of residence
3+ years of experience in an acute care setting
Knowledge of utilization management, quality improvement, discharge planning with transitions of care
Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
Experience with Microsoft Office
MCG certification, if does not have certification, must obtain within 3 months of hire
Independent problem identification / resolution and decision making skills
Able to prioritize, plan, and handle multiple tasks / demands simultaneously
Preferred Qualifications:

Experience working with Medicare members
MCG utilization management experience
Working knowledge of hospice and palliative care
Graduate degree in related field
Working knowledge of SNF & LTAC facilities
Bachelor’s degree in nursing (BSN)
Experience using EMR, utilization management and / or prior authorization systems
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)
 
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.
 
 
Job Keywords: Utilization Management, quality improvement, Nurse, RN, remote, telecommute, work from home