At UnitedHealth Group, you'll improve the health of others while you help us heal the entire health care system. As a Utilization Management Nurse, 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 make an impact? Join us today.
This is a telecommute/work from home position. You will be required to go into the office in the greater Casper and Cheyenne Wyoming areas to complete chart audits as needed. If you are located within a Commutable distance of greater Cheyenne WY and Casper WY, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:
- Perform utilization and concurrent review of inpatient cases using Milliman criteria
- Conduct clinical chart assessments
- Discuss cases with treating physicians and other health care professionals to better understand plans of care
- Identify and evaluate delays in care
- Initiate a discharge planning and readmission prevention plan
- Arrange alternative care services and maintain communication with acute long term care, acute rehabilitation or skilled nursing facilities
- Current, unrestricted RN license in the state of Wyoming
- 3+ years of RN experience, including recent clinical experience in an inpatient/acute setting
- Demonstrate a proficiency in computer skills – windows, IM, excel (Microsoft suite), Outlook, clinical platforms
- A designated home work space and access to install secure high-speed internet via cable/DSL
- Case management certification
- Case management experience
- 1 year or more of UM/UR experience required including experience performing admission and continued inpatient stay reviews using either Interqual or MCG criteria.
- Experience in acute long-term care, acute rehabilitation or skilled nursing facilities
- Experience in discharge planning
- Experience in chart review
- Experience with utilization review for an insurance company or in a managed care environment
- Familiarity with Milliman criteria guidelines
- Undergraduate or higher degree
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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. Job Keywords: Utilization Review, Utilization Management, Concurrent Review, MCG, Milliman, Interqual, UM, UR, RN, Registered Nurse, Inpatient, Discharge Planning, Telecommute, Work From Home, Cheyenne, Casper, WY, Wyoming, Colorado, Fort Collins