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Overnight Remote Utilization Review Jobs in Minnesota

Responsibilities includes preparation, review and negotiation of prospective reinsurance term ... Utilization of artificial intelligence tools and resources (e.g. generative Al). What you bring:

Pricing Manager - Remote

Minneapolis, MN · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Lead pricing review and oversee approval processes for customer quotes, bids and contracts ... including overnight travel It would be a plus if you also possess previous experience in:

Underwriter Senior - Actuary | Remote

Minneapolis, MN · On-site +1

$102K - $121K/yr

... • Review contract terms to ensure risks are appropriately controlled • Conduct transaction ... Utilization of artificial intelligence tools and resources (e.g. generative AI). What you bring ...

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Overnight Remote Utilization Review information

What is the difference between Overnight Remote Utilization Review vs Daytime Remote Utilization Review?

AspectOvernight Remote Utilization ReviewDaytime Remote Utilization Review
Work HoursTypically overnight shifts, often 10 PM to 6 AMStandard daytime hours, usually 8 AM to 4 PM
CertificationsSame as utilization review roles, e.g., RN, CPC, or other healthcare credentialsSame as overnight roles, requiring similar certifications
Work EnvironmentRemote, focused on reviewing cases during night hoursRemote, reviewing cases during daytime hours
Employer & IndustryHealthcare insurance companies, third-party administratorsSame as overnight, within healthcare and insurance sectors

Overnight Remote Utilization Review involves reviewing cases during night hours, providing flexibility for healthcare providers and insurers. Daytime Remote Utilization Review occurs during regular business hours. Both roles require similar credentials and work environments but differ mainly in shift timing, catering to different operational needs.

What are the main challenges faced by overnight remote utilization review professionals, and how can they be addressed?

Overnight remote utilization review professionals often encounter challenges such as working independently during non-traditional hours, limited immediate access to colleagues or supervisors, and the need to make timely decisions with potentially less available support. To address these challenges, it is important to develop strong self-management skills, establish clear communication channels with team members, and utilize comprehensive digital resources and documentation. Employers typically provide thorough training and access to on-call support to help ensure that overnight staff can make confident, accurate determinations and maintain high-quality patient care standards.

What are the key skills and qualifications needed to thrive as an overnight remote utilization review?

To thrive as an Overnight Remote Utilization Review nurse, you need a current RN license, strong clinical judgment, and experience in acute care or case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare/Medicaid are typically required. Excellent critical thinking, attention to detail, and the ability to communicate clearly in written and verbal forms are vital soft skills for this role. These skills ensure accurate, timely case reviews and effective collaboration with healthcare providers while maintaining compliance with payer requirements.

What is an overnight remote utilization review?

An Overnight Remote Utilization Review position involves evaluating medical records and healthcare services during nighttime hours to ensure that treatments are medically necessary and meet established guidelines. Professionals in this role usually work from home, reviewing patient cases, authorizing or denying services, and collaborating with healthcare providers. This job is crucial for maintaining quality care while controlling healthcare costs, and it often requires clinical credentials such as RN, LPN, or other relevant certifications. Strong analytical, communication, and computer skills are important for success in this remote role.

What are the most commonly searched types of Remote Utilization Review jobs in Minnesota?

The most popular types of Remote Utilization Review jobs in Minnesota are:

What cities in Minnesota are hiring for Overnight Remote Utilization Review jobs?

Cities in Minnesota with the most Overnight Remote Utilization Review job openings:

Medical Director Oncology - Utilization Management - Remote anywhere in US

UnitedHealth Group

Minneapolis, MN • Remote

$238K - $357K/yr

Full-time

Retirement

Re-posted 27 days ago


UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

189th of 887 rated healthcare providers


Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Medical Director Oncology will provide utilization review determinations and support case and disease management teams to achieve optimal clinical outcomes.

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

Primary Responsibilities:

  • Perform utilization review determinations for oncology populations, and support case and disease management teams to achieve optimal clinical outcomes
  • Serve as a subject matter expert in evidence - based oncology guidelines, especially those produced by the National Comprehensive Cancer Network (NCCN), and help ensure all clinically relevant policies and processes are informed by the best available evidence
  • Engage and collaborate with treating providers telephonically; This will include discussion of evidence-based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expense
  • Enhance clinical expertise of the Oncology team through education sessions with nursing teams, and serving as a thought leader and point of contact for relevant medical societies and stakeholders
  • Evaluate clinical and other data (e.g., quality metrics, claims and health record data, utilization data) to identify opportunities for improvement of clinical care and processes
  • Collaborate with operational and business partners on enterprise-wide research and clinical and quality initiatives to enhance Optum impact in the oncology field

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:

  • MD or DO with an active, unrestricted medical license
  • Obtain additional licenses as needed 
  • Current Board Certification in an ABMS or AOBMS specialty in Oncology
  • 5 years of clinical practice experience (inclusive of Medical Oncology)
  • Experience working with NCCN guidelines
  • Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, case management, disease management, quality management, product development, and/or peer review
  • Participate in rotational holiday and call coverage

Preferred Qualification:

  • Experience in managed care and quality management

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

The salary range for this role is $238,000 to $357,500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

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


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