Utilization Management Nurse - Honolulu, HI - Field based telecommuting role! at Honolulu

Theres an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isnt for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your lifes best work.(sm)

Get better informed to determine your fit into this position. Click here to view the Realistic Job Preview: Onsite_UM_Nurse.pdf

UnitedHealthcare has anoutstanding opportunity availablefor a field-basedOn Site Utilization Management Nurse in Honolulu, HI. In this rewarding and challenging role, thesuccessful candidate will beresponsible for utilization management and review of inpatient stays for Medicare and Medicaid recipients. The UM Nurse performs on site reviews of current Acute Inpatient Services and determines medical appropriateness ofthose servicesfollowing an evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescribed. The On Site Utilization Management RN works under the direct supervision of an RN or MD.

Field-based/telecommuting opportunity, but interested applicants must be available to attend weely meetings in ourHonolulu office.

Primary Responsibilities:

Provides authorizations and/or denials based on clinical documentation review and medical necessity.
Collects patient utilization data on site at local facilities and via fax and e-mail
Collaborates closely with the Medical Director for complex cases.
Develops expertise in a managed care plan Utilization Managementprocess.
Identifies solutions to non-standard requests and problems.
Solves moderately complex problems and/or conducts moderately complex analyses.
Provides explanations and information to others on difficult issues

Job Keywords: RN, Registered Nurse, Nursing, Honolulu, Case Manager, Case Management  RequirementsRequirements:

Current and unrestricted RN license for the State of Hawaii
Minimum3years ofacute care or case managementexperience

Demonstratedcomputer proficiency ina Windows environment

Current and unrestricted drivers license and proof of auto insurance
Desired Assets

Strong knowledge of Medicaid and Medicare plans

Experience working in utilization management is highly preferred

Discharge planning experience

Experience working with Milliman and/or Interqual

UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

When you work with UnitedHealthcare, what you do matters. Its that simpleand its that challenging.

In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.


Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Country: USA, State: Hawaii, City: Honolulu, Company: UnitedHealth Group.