Are you ready for your next challenge? Discover it here at UnitedHealthcare and help us reinvent the health system. This can be your opportunity to take on a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. You will discuss cases with treating physicians and other healthcare professionals to ensure our members receive the proper health services. You will be required to maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities in order to help patients through their care plan. This is an exciting opportunity at a truly inspired organization. Join us. This can be the start of your life's best work.(sm) What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Primary Responsibilities:Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information Function as a member of a self-directed team to meet specific individual and team performance metrics Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information Acts as a resource for others with less experience Work independently and collaborating with Medical Directors and non-clinical partners Adapt to a highly changing environment and a heavy case load The hours for this position are M-F 9-6 plus ON CALL duties This team crosses all lines of business, processes, and platforms. The team monitors inpatient admissions, outpatient procedures on the EPAL, facility to facility transfers (foreign hospitals to acute inpt. rehab), and air ambulance (international and domestic) reviews. The air ambulance team has required on call duties and is available 24/7. On-call rotates to one week a month and at times 2 weeks a month due to calendar and/ or PTO. This is a high profile fast paced team with short regulatory requirements and contact with multiple departments, members, vendors and work closely with medical directors.
Required Qualifications:A current unrestricted RN license in the state of residency Minimum of 3 years total RN experience including recent clinical experience in an inpatient/acute setting Demonstrate a proficiency in computer skills - Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel and Outlook Exemplary clinical documentation skills; critical thinking skills Must have a quiet designated work space and access to install secure high speed internet (minimum speed 1.5 download mps & 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement) Preferred Qualifications:UR / UM, previous air ambulance review flight nurse experience NLC (Nurse License Compact) RN license Bachelor's Degree Background involving utilization review for an insurance company or experience in case management Familiarity with Milliman Care Guidelines Excellent communication skills both verbal and written Demonstrated written proficiency for SpanishIf the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)Diversity creates a healthier atmosphere: 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: RN, Nurse, Preservice, Pre-Service, UM, UR, Clinical Review, Clinical Coverage, Utilization Management, Utilization Review, Case Manager, Case Management, LTC, Long Term Care, Medicaid, Telecommute, Telecommuting, Work From Home, Milliman, MCG, InterQual, UHG, UnitedHealth Group, UHC, UnitedHealthcare, Air Ambulance review, flight nurse
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.