Remote Utilization Management RN – AZ

Requisition Number: 2192409
Job Category: Nursing
Primary Location: Phoenix, AZ
(Remote considered)

$5000 Sign on Bonus for External Candidates 

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 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?

***Although this position is remote, applicants must be located in Arizona***

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

Primary Responsibilities: 

• Positions in this function require unrestricted RN licensure
• Function is responsible for utilization management which includes Concurrent Review (on-site or telephonic Inpatient Care Management). Performs reviews of current inpatient services.
• Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
• Generally, work is self-directed and not prescribed.
• Works with less structured, more complex issues.
• 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

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. 

Years of post-high school education can be substituted/is equivalent to years of experience

Required Qualifications

• Unrestricted RN license required in state of residence – Arizona
• 3+ years of Managed Care and/or Clinical experience
• Proven basic computer skills with MS Outlook, Word and Excel

Preferred Qualifications

• Certified Case Manager (CCM)
• Pre-authorization experience
• Multi-Specialty experience
• Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance
• Utilization Management experience
• Case Management experience
• Knowledge of Milliman Criteria

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