North Kansas City, Missouri
Kailua Kona, Hawaii
Baltimore, Maryland
Posted: 01-Nov-24
Location: Denver, Colorado
Salary: Open
Categories:
Internal Number: 143946554
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?
The schedule expectations for this position will include weekends, rotating holidays and will work 8am-5pm MST to support our patients.
Primary Responsibilities:
- Positions in this function require unrestricted compact RN licensure
- Function is responsible for utilization management which includes inpatient review for level of care and length of stay
- Prior Authorization Review of skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospital
- Determines medical appropriateness of level of care 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.
Required Qualifications:
- RN License
- 3+ years of Managed Care and/or Clinical experience
- Proven basic computer skills with MS Outlook, Word and Excel
Preferred Qualification:
- Prior-authorization experience
- Multi-Specialty experience
- Utilization Management experience
- Case Management experience
- Experience in a skilled nursing facility or inpatient rehabilitation facility
- Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance
- Knowledge of Milliman Criteria
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Nevada or Washington Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
