Remote Utilization Management Nurse RN, MN


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Requisition Number: 2176737
Job Category: Nursing
Primary Location: Plymouth, MN
(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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work.SM 

The Utilization/Retrospective Review Nurse conducts retrospective review of medical records to validate appropriateness, level of care, quality of care, as well as accuracy of payment utilizing study methodologies.

Schedule:  This position is full-time, Monday – Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Responsible for reviewing prospective, concurrent, and retrospective reviews for medical necessity and appropriateness of service and care including specialist, outpatient and ancillary services, outpatient surgery, and any high dollar cases. Applying Interqual criteria.
  • Responsible for first level retrospective review denials issued by Agency to determine appropriateness of denial reason and necessity of Reconsideration/Appeal. Applying Interqual criteria.
  • Responsible for maintaining work queue, aging, and timeliness of reviews according to department SLA’s/metrics
  • Responsible for meeting and/or exceeding department productivity metrics according to state/department protocols.
  • Attend staff meetings and education trainings necessary to maintain current nursing and UM knowledge
  • Participate actively in company issued LEAN activates to support the goals of the Department

What are the reasons to consider working for UnitedHealth Group?  Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
  • More information can be downloaded at:

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:

  • Associate Degree (or higher) in Nursing
  • Current unrestricted RN license in state of residence
  • 3+ years of acute care experience in Medical/Surgical/ICU/Emergency Room/Behavioral Health/Public Health
  • Intermediate level of knowledge of CMS regulatory requirements, specifically as they relate to UM/Health Plan correspondence
  • Intermediate level of knowledge of Interqual criteria

Preferred Qualifications:

  • Bachelor’s Degree (or higher) in Nursing
  • 2+ years of utilization management experience in a health care delivery setting, specifically in authorization services
  • 1+ years of Quality Management experience
  • High attention to detail in documenting UM referral reviews
  • Knowledge of ICD-10 & CPT coding as it relates to Inpatient/Outpatient services
  • Knowledge of EMR systems, i.e EPIC, Meditech, Powerchart/Cerner

Soft Skills:

  • Ability to work independently & proactively while maintaining accuracy and timeliness of inventory

Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.


California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington Residents Only: The salary range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington 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.


At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. 



Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and 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.