LTSS Utilization Management RN - Remote in FL

If you reside in the state of Florida, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities

• Perform utilization management, utilization review, or concurrent review
• Determine medical necessity for in home LTC services and support
• Identify solutions to non-standard requests and problems
• Work with minimal guidance; seeks guidance on only the most complex tasks
• Translate concepts into practice
• Provide explanations and information to others on difficult issues
• Coach, provide feedback and guide others
• Act as a resource for others with less experience
• Critical analysis of case manager UM submission with review of supporting tools
• Communication and collaboration with Medical Director
• Case preparation and presentation for Medical Director review
• Review and provide documentation in supportive rationale for UM decision
• Timely and accurate documentation in ICUE and Community Care of UM decision

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

• Unrestricted RN license required in state of Florida
• Managed Care and / or Clinical experience preferably working within Medicaid and Utilization Management
• Ability to create, edit, save and send documents utilizing Microsoft Office (Word, Excel, PowerPoint)
• Ability to navigate a Windows environment

Preferred Qualifications

• Undergraduate degree
• Certified Case Manager (CCM)
• State Medicaid Managed Care experience
• Pre-authorization experience
• Utilization Management experience
• Case Management experience
• Medicaid Utilization Management experience
• Experienced in Medicare utilization management

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.