Senior Utilization Management Nurse RN Compact Lics - Remote Eligible

Sr Utilization Management Nurse

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.

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

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

As a Sr Utilization Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives.

Primary Responsibilities:

• Perform utilization management, utilization review
• Perform prospective review utilizing criteria which can include company guidelines and/or State mandates
• Discuss requests with treating physicians and other healthcare professionals to better understand plan of care
• Identify and evaluate delays in care
• Gather clinical information to assess and expedite care needs following company policies
• Ensure compliance with relevant processes, procedures and regulations
• Demonstrate business/industry knowledge
• Drive effective clinical decisions within a business environment
• Maintain appropriate legal documentation within operating platform
• Consult with the Medical Director as needed to troubleshoot difficult or complex cases and if medical necessity criteria is not met
• Participate in telephonic (WebEx) staff meetings and on-line learning
• Other duties and responsibilities, not specifically described, may be defined or assigned that is consistent with knowledge, skills and abilities of the incumbent by management

Required Qualifications:

• Current, unrestricted RN license in the State of Residence
• Willingness and ability to obtain additional licensures as needed
• 3+ years of RN experience in a fertility clinic/women's health
• 1+ years demonstrated leadership background (can include mentorship or committee involvement)
• 1+ years of experience as an UM RN in a managed care setting performing fertility benefit and medical necessity reviews
• Ability to mentor and support other team members as determined by the business
• Proven computer proficiency, to include solid data entry skills and the ability to navigate a Windows environment

Preferred Qualifications:

• Bachelor’s degree
• Compact License
• Managed care

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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. OptumCare is an Equal Employment Opportunity employer qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.