Utilization Management Nurse RN - CA - 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.  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)
 
UnitedHealthcare has an excellent opportunity available for a California licensed RN to work from home anywhere in the state.  In this Concurrent Review role, the successful candidate will be assigned to multiple hospital facilities. Want to learn more before applying for this role?
 
*Must Reside in the state of California*
 
 
Primary Responsibilities:

Perform utilization and concurrent review using Milliman criteria
Conduct clinical chart assessments
Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care
Identify and evaluate delays in care
Initiate a discharge planning and readmission prevention plan when applicable
Approve bed days for inpatient cases when applicable
Arrange alternative care services; Contact and maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum
Gather clinical information to assess and expedite care needs
Maintain appropriate documentation
Consult with the Medical Director as needed to troubleshoot difficult or complex cases
Participate in telephonic staff meetings
Repatriate patients to a in network facility when appropriate
 

Required Qualifications:  

Unrestricted RN license required in state of residence
3 or more years of Managed Care and/or Clinical experience  
Ability to create, edit, save and send documents utilizing Microsoft Word. Ability to navigate a Windows environment
Preferred Qualifications:

Pre-authorization experience  
Utilization Management experience  
Case Management experience  
Knowledge of Milliman Criteria  
Certified Case Manager (CCM)  
Undergraduate degree  
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: RN, Registered Nurse, UR, UM, Utilization Review, Utilization Management, Concurrent Review, Milliman, InterQual, Managed Care, Insurance, Case Management, Case Manager, Discharge Planning, Chart Review, Pre-Authorization, Cypress, CA, California, Telecommute, Telecommuter, Telecommuting, Remote