Utilization Management RN, Prior Authorizations – Telecommute

UnitedHealth Group
August 27, 2021
Denver, CO
Job Type


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)

At Optum, the mission is clear:  Help people live heathier lives and help make the health system work better for everyone.  LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well-being of Americans.  By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.

LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient-specific in-clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. 

As a Utilization Management RN - Prior Authorizations, you can assess and coordinate care for a very diverse population of members of the World Trade Center (WTC) Health Program throughout the United States. This is a multifaceted role that is highly rewarding as your work is helping people live healthier lives.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

The primary hours for this position are Monday - Friday, 8am - 5pm in the local time zone. Candidates must have the ability to flex hours as needed to accommodate overall business hours of 8am to 5pm in each time zone.

A compact RN license is strongly preferred.

Primary Responsibilities:

  • Educate and inform members of program coverage and limitations while ensuring that high quality and cost-effective care is provided within contract requirements
  • Use critical thinking and problem-solving skills to navigate through the complexities of a member’s health conditions while maintaining coverage within the program guidelines
  • Coordinate health care services for members
  • Prepare and summarize medical history information on members to present to the Medical Director
  • Cultivate relationships with members, providers, co-workers, and other team members to ensure program compliance and member satisfaction
  • Manage inbound and outbound calls from providers to prior authorize tests and procedures related to members’ certified health conditions and program coverage
  • Review medical records (monitoring, treatment and supportive) to determine WTC relatedness for potential program coverage and communicate results to members
  • Complete system-generated tasks, including documenting all results as required in internal database (MedNet)
  • Prepare comprehensive reviews and summaries for medical appeals, determination of coverages, and requests for treatment services
  • Point of contact for internal departments to answer questions relative to members of their assigned caseload
  • Complete medical health questionnaires 

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:

  • Active, unrestricted RN license in the State of Residence
  • 3+ years of clinical experience as a Registered Nurse
  • 2+ years of utilization management experience, including prior authorizations, in an insurance or managed care environment
  • Experience with Microsoft Office programs including MS Word and MS Outlook
  • Equivalent combination of education, experience and/or applicable military experience will be considered

Preferred Qualifications: 

  • Compact RN license
  • National Career Readiness Certificate
  • Case Management experience
  • Military healthcare experience
  • Medical call center experience or medical related experience in a corporate/business setting
  • Behavioral health, occupational health, or medical/surgical background
  • Knowledge of ICD and CPT coding
  • URAC / ISO experience / knowledge
  • Effective interpersonal, communication, and problem-solving skills 
  • Demonstrated organizational and multi-tasking abilities
  • Solid telephone communication skills
  • Ability to work independently as well as on a team
  • Ability to implement critical thinking and decision-making skills to identify appropriate care/treatment plans for a wide range of members from low to high complexity
  • Ability to take initiative and be detail-orientated

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 do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $53,300 to $95,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job keywords: Utilization Management RN, Prior Authorizations, Registered Nurse, RN, utilization management, insurance, managed care, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, La Crosse, WI, Wisconsin, Atlanta, GA, Georgia, Houston, TX, Texas, Denver, CO, Colorado, Phoenix, AZ, Arizona, St. Louis, MO, Missouri

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