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Clinical Review Nurse - Concurrent Review - Remote MN id-19075

UnitedHealth Group is seeking a Clinical Review Nurse to join our Concurrent Review team. This fully remote position is based in Minnesota, providing an opportunity to make a meaningful impact on patient care while working from the comfort of your home.

Job Description

As a Clinical Review Nurse, you will play a vital role in ensuring patients receive appropriate, timely, and cost-effective care. You will conduct clinical reviews of inpatient services, assess medical necessity, and collaborate with healthcare providers to optimize patient outcomes. Your expertise will help maintain high-quality standards while ensuring compliance with healthcare regulations and policies.

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Responsibilities

  • Perform concurrent reviews of inpatient hospital stays, ensuring medical necessity and appropriate level of care.
  • Assess clinical documentation and determine if treatment aligns with established guidelines.
  • Collaborate with physicians, hospital staff, and case managers to facilitate optimal patient care and discharge planning.
  • Identify potential quality of care issues and escalate them as needed.
  • Maintain compliance with regulatory and accreditation standards, such as Medicare, Medicaid, and NCQA.
  • Document clinical review findings accurately and promptly in electronic systems.
  • Provide education and support to healthcare providers on utilization management best practices.

Requirements

Required Qualifications:

  • Active, unrestricted RN license in Minnesota (or compact state license applicable to MN).
  • 2+ years of clinical nursing experience in an acute care, hospital, or case management setting.
  • Experience with concurrent review, utilization management, or case management.
  • Strong understanding of medical necessity criteria (e.g., InterQual, MCG guidelines).
  • Proficiency in electronic medical records (EMR) and healthcare technology.
  • Ability to work independently in a fast-paced, remote environment.
  • Strong communication and critical thinking skills.

Preferred Qualifications:

  • BSN or higher degree in Nursing.
  • Previous experience in managed care, insurance, or health plan settings.
  • Certified Case Manager (CCM) or Utilization Review certification.

Benefits

At UnitedHealth Group, we value our employees and offer a comprehensive benefits package, including:
✅ Competitive salary & performance-based incentives
✅ Health insurance (Medical, Dental, Vision)
✅ 401(k) with company match
✅ Paid Time Off (PTO) and holidays
✅ Tuition reimbursement & career development programs
✅ Employee wellness programs and telehealth services

Why Join Us?

At UnitedHealth Group, we are dedicated to transforming healthcare and making a difference in people's lives. As a Clinical Review Nurse, you will:

  • Be part of a supportive and collaborative team that values your expertise.
  • Have opportunities for professional growth and advancement.
  • Enjoy the flexibility of working remotely while maintaining a healthy work-life balance.
  • Work for a company that is committed to innovation, quality care, and employee well-being.

How to Apply

Ready to make an impact? Apply today! Click the link below to submit your application and take the next step in your career with UnitedHealth Group.

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