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Job Details

UnitedHealth Group

Prior Authorization/Utilization Management RN - Integrated Care Team - Telecommute




Phoenix, Arizona, United States

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 and help people live healthier lives while doing your life's best work.(sm)
The Integrated Care Team leverages a cross-functional approach, supporting the member end to end, with close collaboration and co-management. Generally, work is self-directed and not prescribed; is able to work with less structured and more complex issues. The team will manage the full array of health care services, spanning both outpatient and Inpatient settings and with support from some specialized clinical teams.
This new cross-functional collaboration provides an opportunity to deliver the next generation clinical model, integrating services from precertification (PA), inpatient concurrent review (ICM), post-acute review (PACM), discharge planning (DCM), medical and behavioral care management and prevention to improve quality of care and patient outcomes. Employees in this role will be cross-trained on multiple roles (PA, ICM, PACM, DCM) to support fluctuating inventory within the Integrated Care Team.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Perform initial and ongoing reviews pertaining to primary role (PA, ICM, DCM, PACM), appropriately applying clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and sending to Medical Directors if review is necessary for determining an adverse determination.
  • Collaborate with Medical Directors, clinical peers and Health Plan partners on performing appropriate clinical decision making and/or referrals
  • Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
  • Follow all Standard Operating Procedures in end-to-end management of cases
  • Participate in team meetings, education discussions and related activities
  • Maintain compliance with Federal, State and accreditation organizations
Required Qualifications:
  • A current, unrestricted RN License
  • Nurse Licensure Compact (NLC)
  • State of Washington RN Licensure OR williness to obtain RN license in Washington
  • 3+ years of experience as a Registered Nurse (RN) experience
  • Demonstrate a proficiency in computer skills - Windows, MS Suite (Word, Excel, Outlook), clinical platforms
  • Have a designated workspace and access to install secure high-speed internet via cable/fiber optic/DSL in home
Preferred Qualifications:
  • Bachelor's Degree
  • Utilization Management/Utilization Review experience
  • Preservice Review/Prior Authorization experience
  • Experience in discharge planning and/or chart review
  • Familiarity with InterQual or MCG criteria guidelines
  • Familiarity with CMS guidelines/regulations
  • Familiarity with Medicaid guidelines/regulations
To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
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)
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $53,300 to $95,100. The salary range for Connecticut/Nevada residents is $58,800 to $104,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.
*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.