Remote Fertility Utilization Management RN

Requisition Number: 2190692
Job Category: Nursing
Primary Location: Fort Worth, TX
(Remote considered)

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

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 at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You’ll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact?

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. The work schedule for this position is 8a – 5:30p Central Time, Monday – Friday.

Primary Responsibilities: 

• Determine the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
• Identify solutions to non-standard requests and problems
• Translate concepts into practice
• Act as a resource for others; provide explanations and information on difficult issues
• Generally, work is self-directed and not prescribed
• Works with less structured, more complex issues
• Serves as a resource to others
• It feels great to have autonomy, and there’s also a lot of responsibility that comes with it. In this role, you’ll be accountable for making decisions that directly impact our members. And at the same time, you’ll be challenged by leveraging technologies and resources in a rapidly-changing, production-driven environment.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Required Qualifications: 

• Current unrestricted RN licensure in state of Residence
• Compact license and/or willingness to obtain additional licenses in the following states: CA, NV, NM, OK, WA and WY
• 3+ years of Managed Care and/or Clinical experience
• 1+ years of fertility experience
• Proven computer proficiency, to include strong data entry skills and the ability to navigate a Windows environment
• Willing or ability to work on core hours 8a – 5:30p CST

Preferred Qualifications:

• Certified Case Manager (CCM)
• Pre-authorization experience
• Utilization Management experience
• Case Management experience
• 3rd party reproduction knowledge
• Knowledge of Milliman Criteria

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $56,300 to $110,400 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy