LTSS Utilization Management RN - Remote in FL
About the role
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. If you reside in the state of Florida, you will have the flexibility to work remotely* as you take on some tough challenges.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone—of every race, gender, sexuality, age, location and income—deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes—an enterprise priority reflected in our mission.
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
Requirements
- Unrestricted RN license required in state of Florida
- Managed Care and