Remote RN Utilization Management Nurse CST EST

Requisition Number: 2174622
Job Category: Nursing
Primary Location: Atlanta, GA
(Remote considered)

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life’s best work.(sm) 

If you are located in CST or EST, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities: 

• Perform initial and concurrent review of inpatient cases applying MCG criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination
• Discuss cases with facility healthcare professionals to obtain plans-of-care
• Collaborate with UnitedHealthcare Medical Directors on performing utilization management
• Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
• Consult with the Medical Director as needed for complex cases and make appropriate referrals to sister segments
• Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
• Identify delays in care or services and manage with MD
• Follow all Standard Operating Procedures in end-to-end management of cases
• Obtain clinical information to assess and expedite alternate levels of care
• Facilitate timely and appropriate care and effective discharge planning
• Participate in team meetings, education discussions and related activities
• Maintain compliance with Federal, State and accreditation organizations
• Identify opportunities for improved communication or processes
• Participate in telephonic and in-person staff meetings
• Plan for MCG Certification

This position does require you to work a weekend (Saturday-Sunday) rotation throughout the year. If you work a weekend day you will receive a day-off  during the week and differential pay for the weekend day you work. 

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 license in resident state
• 3+ years of total experience, including recent clinical experience in an inpatient/acute setting
• Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
• Experience performing discharge planning
• Experience in utilization review and/or utilization management
• Solid computer skills

Preferred Qualifications:

• Bachelor’s degree
• Experience with MCG Guidelines or InterQual
• Demonstrated ability to work independently
• Demonstrated effective verbal and written communication skills

Careers at OptumCare. We’re on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we’re creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life’s best work.(sm)  

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Connecticut, New Jersey, New York, or Rhode Island Residents Only: The salary range for Connecticut, New Jersey, New York, or Rhode Island residents is $56,300 to $110,400. 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