Remote Utilization Management Nurse, RN, FL

Requisition Number: 2193817
Job Category: Nursing
Primary Location: Miami, FL
(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. 

As a Inpatient Utilization Management Nurse, RN (Telecommute/Florida Applicants Only), 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.

Work Schedule: Monday – Friday (8am – 5pm EST)

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

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
• Act as a resource for others; provide explanations and information on difficult issues
• Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (MCG / InterQual criteria)
• Discuss cases with facility healthcare professionals to obtain plans-of-care
• Collaborate with Optum Enterprise Clinical Services 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 downstream partners
• 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

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:

• A current, unrestricted RN license and residence in state of Florida
• 3+ years of acute clinical nursing experience (Acute Inpatient, Emergency Department)
• 1+ years of experience of utilization review and evidence-based guidelines (MCG, InterQual Guidelines)
• Intermediate proficiency in computer skills – Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms
• Designated workspace and access to install secure high-speed internet via cable / DSL in home

Preferred Qualifications:

• Bachelor’s degree
• Compact licensure
• 2+ years utilization management experience
• Managed Care experience
• Discharge planning experience

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