Utilization Management Nurse, RN - West Valley City, UT - Full-time / Part-time

Optum Medical Network is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve.  Optum Medical Network's focus is to do the right things for patients, physicians, and the community. Optum Medical Network's Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients.  The current focus of Optum Medical Network is on seniors, and those with complex care needs, who most benefit from a high touch model of care.

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.

Want to learn more before applying for this role? Click here to view the Realistic Job Preview:

Not a telecommute position - 40 hours per week.


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
  

Utilization Review / Concurrent review experience preferred

Bilingual (Spanish) desirable

Required Qualifications:

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  LVN license is required in state of residence



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  3 or more years of Managed Care and/or Clinical experience required



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  Ability to create, edit, save and send documents utilizing Microsoft Word. Ability to navigate a Windows environment

Preferred Qualifications:

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  Unrestricted RN license required in state of residence



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  Pre-authorization experience



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  Utilization Management experience



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  Case Management experience



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  Knowledge of Milliman Criteria



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  Certified Case Manager (CCM)



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  Undergraduate degree
  

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: 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 Manager, Case Manager, utilization review, West Valley City, UT, Utah