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Careers at UnitedHealth Group


We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Admin Support Services


United States

Postal Code:


Approximate Salary:

Not Specified

Position Type:

Full Time

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Utilization Management Review Nurse - RN (Per Diem) - Melville, NY

UHG - Melville, New York

Posted: 10/12/2018

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.SM


In this position Utilization Management Review Nurse - RN (Per Diem) - Melville, NY, you will be assisting with Denial Prevention. Responsibilities include doing initial reviews on urgent admissions and upgrades, sending reviews to insurance carriers and validating the need for admissions. 


Work days will fluctuate based on business needs.

Primary Responsibilities:

  • Performs initial concurrent utilization management reviews using MCG/Allscripts criteria.
  • Conducts clinical chart review for appropriateness of admission and continued length of stay.
  • Contacts and interacts with third party payers as needed to obtain approval of hospital days
  • Ensures compliance with current state, federal, and third party payer regulations.
  • Identifies patients for Observation level of care and notifies appropriate health team members.
  • Communicates with insurance companies and physicians regarding utilization issues.
  • Ensures managed care reviews are up to date and accurately reflect patient’s clinical progress and acute needs.
  • Performs related duties, as required.
  • Utilizes Allscripts, Sunrise, Word and Outlook.
  • Unrestricted RN license in the state of NY

Required Qualifications:

  • High School Diploma / GED or higher
  • Must have an active RN license for the state of New York
  • 3+ years as an RN in a clinical setting
  • Proficient in Microsoft Word (creating and editing documents) and Outlook (calendar and email)
  • Must have a flexible schedule and the ability to work Monday to Sunday on as needed basis – per diem.

Preferred Qualifications:

  • 1+ years experience as a RN in Case Management or Quality Assurance setting
  • Experience with Allscripts (for clinical review of chart) and/or Sunrise (clinical application for electronic medical records)

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM


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.


Keywords: UnitedHealth Group, Optum, RN, Per Diem, Melville, New York, Case Management, Healthcare, RN

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