Utilization Review Nurse (Recent growth position!)

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.



Optum delivers personal health management solutions designed to help individuals stay healthy, get healthy and live with illness. Evidence-based medicine, technology and specially trained nurses are combined to identify an individual’s health needs, make referrals to appropriate resources and close gaps in care. With capabilities ranging from wellness promotion to self-care and triage to longitudinal case management, Optum delivers an integrated, cohesive approach to managing the health of each individual--as an individual.

 

We offer an opportunity to truly make a difference while advancing your career. It’s a rare combination that makes Optum the ideal place for your professional and personal satisfaction.

 

Do you need a change? We have a unique opportunity in our case management division that would allow you to use your clinical skills to make a positive impact in the lives our patients – without direct patient interactions or the headache of long nights, weekends and on-call shifts. If this sounds appealing, we encourage you to apply.

 

Key responsibilities of the Utilization Review Nurse include:
Reviewing cases to determine the medical necessity of concurrent and retroactive acute inpatient hospitalizations
Making sure member conditions/illnesses meet the criteria for insured treatments
Collecting clinical information to review and certify determinations
Using clinical data and personal expertise to identify appropriate care in terms of setting, treatment, delivery and recovery planning
Relaying cases to the Medical Director when necessary



Only licensed Texas RNs with related clinical experience will be considered for this role. We need a nurse with a background in acute, sub-acute, inpatient, outpatient or long-term care. Utilization review experience is a must, and managed care experience is strongly preferred. Case management and telephonic triage experience would be very helpful in this role. PC proficiency is essential, and familiarity with Milliman or InterQual guidelines would be a plus. If you meet these criteria, and you’re a self-directed nurse with an excellent work ethic and a strong sense of leadership, we urge you to contact us regarding this role.

 

UnitedHealth Group offers a full range of comprehensive benefits, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.

 

If you are interested in growing professionally within an innovative, highly respected organization, we invite you to explore this excellent growth opportunity!

 

Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.