Remote Utilization Management RN – Optum AZ

Optum

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Requisition Number: 2194069
Job Category: Nursing
Primary Location: Phoenix, AZ
(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?

To be considered for this position you must reside in Arizona as a licensed RN.  You will have the opportunity to work remotely in Arizona only 

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.

One year of post-high school education can be substituted/is equivalent to one year of experience.

Required Qualifications:

  • Unrestricted RN license in AZ
  • 3+ years of Managed Care and/or Clinical NICU experience
  • Basic computer skills with MS Outlook, Word and Excel

Preferred Qualifications:

  • Utilization Management experience
  • Compact RN License
  • Certified Case Manager (CCM)
  • 3+ years experience of NICU Level
  • Multi-Specialty experience
  • Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance
  • Case Management experience
  • Knowledge of InterQual Criteria

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