About the Company
UnitedHealth Group is a diversified health care company dedicated to helping people live healthier lives and helping make the health system work better for everyone. We are committed to making a difference in the lives of millions and are recognized as a leader in healthcare innovation and service delivery across the United States and globally. Join our team and contribute to a healthier future.
Job Description
We are seeking a dedicated and detail-oriented Utilization Review Nurse with an administrative focus to join our remote team. In this role, you will be responsible for applying clinical knowledge to assess the medical necessity of healthcare services, ensuring appropriate utilization of resources, and compliance with healthcare guidelines. This position requires strong critical thinking, excellent communication skills, and the ability to work independently in a fast-paced virtual environment. You will play a crucial role in managing administrative aspects of utilization review, including documentation, data entry, and communication with providers and members. This is a 100% remote position, allowing you the flexibility to work from your home office.
Key Responsibilities
- Perform concurrent and retrospective reviews of medical records to determine the medical necessity and appropriateness of care.
- Apply established clinical criteria and guidelines to all reviews.
- Communicate with providers and members regarding review determinations, providing clinical rationale when necessary.
- Document all review activities accurately and thoroughly in the electronic health record system.
- Identify potential quality of care concerns and refer to appropriate departments.
- Participate in interdisciplinary team meetings and collaborate with case managers and other healthcare professionals.
- Maintain compliance with all regulatory requirements and company policies.
- Contribute to process improvement initiatives within the utilization review department.
- Manage a caseload effectively, prioritizing tasks and meeting deadlines.
- Assist with administrative tasks related to utilization review, including report generation and data analysis.
Required Skills
- Active, unrestricted Registered Nurse (RN) license in any U.S. state (multi-state licensure preferred).
- Minimum of 2 years of clinical experience in an acute care setting.
- Proficiency in interpreting and applying clinical criteria (e.g., InterQual, Milliman).
- Strong understanding of healthcare regulations and compliance standards.
- Excellent written and verbal communication skills.
- Demonstrated ability to work independently and manage time effectively in a remote setting.
- Proficient computer skills, including experience with electronic health records (EHR) and Microsoft Office Suite.
- Strong analytical and problem-solving abilities.
- Experience with administrative tasks in a healthcare setting.
Preferred Qualifications
- Bachelor of Science in Nursing (BSN).
- Certified Professional in Utilization Review (CPUR) or equivalent certification.
- Previous experience in utilization review, case management, or care coordination.
- Experience working in a remote or virtual environment.
- Familiarity with various payer guidelines and medical policies.
- Experience with large healthcare systems or insurance companies.
Perks & Benefits
- Comprehensive health, dental, and vision insurance plans.
- 401(k) retirement plan with company match.
- Paid time off (PTO) and company-paid holidays.
- Employee assistance program (EAP).
- Tuition reimbursement and professional development opportunities.
- Wellness programs and resources.
- Flexible work schedule in a 100% remote environment.
- Opportunities for career advancement within a leading healthcare organization.
- Access to cutting-edge technology and tools for remote work.
- Supportive and collaborative team culture.
How to Apply
If you are interested in this position, please click the "Apply Now" button below. To ensure your application is properly considered, please prepare the following:
- An up-to-date Resume or CV
- A brief cover letter summarizing your experience and motivation
Applications are reviewed on a rolling basis. Only shortlisted candidates will be contacted for an interview.
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