Utilization Management Nurse RN - Telecommute in Massachusetts - 2021985

UnitedHealth Group

Boston Massachusetts

United States

Healthcare - Nursing
(No Timezone Provided)

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at UnitedHealth Group, 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.

If you currently reside in the state of Massachusetts, you’ll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Determine the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
  • Identify solutions to non-standard requests and problems 
  • Participates in regular meetings to collaborate with supporting leadership and team to ensure operational efficiency. 
  • Assures performance adheres with established quality standards, evidenced based practice guidelines and departmental benchmarks and workflows.
  • Act as a resource for others; provide explanations and information on difficult issues
  • Represents the MA MLTSS program in a positive, solution focused manner that embodies our corporate values: Integrity, Compassion, Relationships, Innovation and Performance
  • Minimum 10% travel within the state of MA
  • You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

    Required Qualifications: 

  • High School Diploma/GED
  • Current, unrestricted RN license required in state of Massachusetts
  • 3+ years of Managed Care and/or clinical experience
  • Knowledge of Microsoft Suite; Word and Outlook
  • Preferred Qualifications:

  • Certified Case Management certification
  • Massachusetts state residency
  • Experience with Salesforce LTMS
  • Authorization experience
  • Experience working in community-based settings
  • Experience with home health agencies
  • Knowledge of Medicare and Medicaid
  • UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status.

    We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

    You can learn more about all we are doing to fight COVID-19 and support impacted communities: click here. 

    UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

    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 d o your life's best work.(sm)

    *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

    For more information on our Internal Job Posting Policy, click here.

    Utilization Management Nurse RN - Telecommute in Massachusetts - 2021985

    UnitedHealth Group

    Boston Massachusetts

    United States

    Healthcare - Nursing

    (No Timezone Provided)

    Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

    Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at UnitedHealth Group, 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.

    If you currently reside in the state of Massachusetts, you’ll enjoy the flexibility to telecommute* as you take on some tough challenges.

    Primary Responsibilities:

  • Determine the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
  • Identify solutions to non-standard requests and problems 
  • Participates in regular meetings to collaborate with supporting leadership and team to ensure operational efficiency. 
  • Assures performance adheres with established quality standards, evidenced based practice guidelines and departmental benchmarks and workflows.
  • Act as a resource for others; provide explanations and information on difficult issues
  • Represents the MA MLTSS program in a positive, solution focused manner that embodies our corporate values: Integrity, Compassion, Relationships, Innovation and Performance
  • Minimum 10% travel within the state of MA
  • You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

    Required Qualifications: 

  • High School Diploma/GED
  • Current, unrestricted RN license required in state of Massachusetts
  • 3+ years of Managed Care and/or clinical experience
  • Knowledge of Microsoft Suite; Word and Outlook
  • Preferred Qualifications:

  • Certified Case Management certification
  • Massachusetts state residency
  • Experience with Salesforce LTMS
  • Authorization experience
  • Experience working in community-based settings
  • Experience with home health agencies
  • Knowledge of Medicare and Medicaid
  • UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status.

    We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

    You can learn more about all we are doing to fight COVID-19 and support impacted communities: click here. 

    UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

    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 d o your life's best work.(sm)

    *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

    For more information on our Internal Job Posting Policy, click here.