Remote Utilization Management Nurse RN Florida - Remote Eligible

Requisition Number: 2222435
Job Category: Nursing
Primary Location: Orlando, 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.

What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you’ll open doors for yourself that simply do not exist in any other organization, anywhere.

Work schedule will be Monday – Friday from 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:

• Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (i.e. 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
• Identify opportunities for improved communication or processes
• Participate in audit activities and meetings

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:

• Current, unrestricted RN license in state of Florida
• 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF/AIR/LTAC, Emergency Department, Urgent Care, Doctor’s Office, School Nurse)
• Experience in acute, long term care, acute rehabilitation, or skilled nursing facilities
• 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
• 1+ years of experience involving utilization review and evidence-based guidelines (i.e. MCG, InterQual Guidelines)
• Compact license
• Managed Care experience
• Experience performing discharge planning
• Proven ability to work independently
• Demonstrated effective verbal and written communication skills

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

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.