Utilization Management Nurse RN - Remote PST Hours - Healthcare Innovation and Patient Outcomes

Job Summary

Join the Optum team, a leading global organization dedicated to delivering care and improving health outcomes through innovative technology solutions. As a Utilization Management Nurse RN, you will play a critical role in ensuring that our members receive the right care at the right time. This is a unique opportunity to work remotely in a dynamic environment, leveraging cutting-edge technologies and resources to make a positive impact on the lives of millions of people.

About Optum and UnitedHealth Group

Optum is part of UnitedHealth Group, a global organization that delivers care, aided by technology, to help millions of people live healthier lives. Our mission is to help people live healthier lives and make the health system work better for everyone. We believe that everyone, regardless of their background or circumstances, deserves the opportunity to live their healthiest life. With a culture guided by inclusion, talented peers, comprehensive benefits, and career development opportunities, Optum is an exciting place to start or advance your career.

Key Responsibilities

As a Utilization Management Nurse RN, you will be responsible for:

• Determining the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
• Identifying solutions to non-standard requests and problems, ensuring that our members receive the care they need.
• Translating concepts into practice, applying your knowledge and expertise to real-world scenarios.
• Acting as a resource for others, providing explanations and information on difficult issues and complex medical cases.

Requirements and Qualifications

Essential Qualifications

To be successful in this role, you will need:

• Unrestricted RN license in the state of residence.
• 3+ years of Managed Care and/or Clinical experience, with a strong understanding of medical guidelines and benefit determination.
• Proficiency in MS Office, including Excel, to effectively analyze data and communicate with stakeholders.
• Experience working with multiple EMRs (electronic medical records), to navigate complex medical information systems.

Preferred Qualifications

While not required, the following qualifications are preferred:

• Certified Case Manager (CCM) certification, demonstrating expertise in case management.
• Pre-authorization experience, with a strong understanding of the pre-authorization process.
• Utilization Management experience, with a focus on optimizing patient outcomes.
• Case Management experience, with a strong understanding of case management principles.
• Knowledge of Milliman Criteria, to inform medical decision-making.

Work Environment and Culture

As a remote employee, you will have the flexibility to work from anywhere, while still being part of a dynamic team. Our culture is guided by:

• Inclusion, with a commitment to diversity, equity, and inclusion.
• Talent development, with opportunities for growth and career advancement.
• Comprehensive benefits, including a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution.

Compensation and Benefits

The salary range for this role is $59,500 to $116,600 annually, based on full-time employment. Pay is based on several factors, including local labor markets, education, work experience, certifications, and more. In addition to your salary, UnitedHealth Group offers:

• Comprehensive benefits package, including medical, dental, and vision coverage.
• Incentive and recognition programs, to reward outstanding performance.
• Equity stock purchase, to give you a stake in the company's success.
• 401k contribution, to help you plan for the future.

Career Growth and Learning Benefits

At UnitedHealth Group, we are committed to helping our employees grow and develop their skills. As a Utilization Management Nurse RN, you will have opportunities to:

• Advance your career, with opportunities for promotion and career advancement.
• Develop new skills, through training and development programs.
• Stay up-to-date with industry trends, through ongoing education and training.

Why Join Us?

If you are a motivated and compassionate nurse looking to make a difference in the lives of others, we encourage you to apply for this exciting opportunity. As a Utilization Management Nurse RN, you will be part of a dynamic team dedicated to improving health outcomes and making a positive impact on the lives of millions of people.

At UnitedHealth Group, we are committed to:

• Mitigating our impact on the environment, through sustainable practices.
• Enabling and delivering equitable care, that addresses health disparities and improves health outcomes.

How to Apply

If you are interested in this opportunity, please submit your application through our website. We look forward to hearing from you!

Equal Employment Opportunity: 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.

Drug-Free Workplace: UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.