UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description
AmeriChoice 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.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
The Utilization Management Nurse is responsible for utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescribed. The Utilization Management Nurse works under the direct supervision of an RN or MD.
Primary Responsibilities:
- Works with less structured, more complex issues.
- Serves as a resource to others.
- Assesses and interprets customer needs and requirements.
- Identifies solutions to non-standard requests and problems.
- Solves moderately complex problems and/or conducts moderately complex analyses.
- Works with minimal guidance; seeks guidance on only the most complex tasks.
- Translates concepts into practice.
- Provides explanations and information to others on difficult issues.
- Coaches, provides feedback, and guides others.
Acts as a resource for others with less experience
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Qualifications
Qualifications:
- Unrestricted RN license required in your state of residence
- Undergraduate degree or equivalent experience
- 2 yrs Managed Care and/or Clinical experience required
Additional Assets Preferred:
- Pre-authorization experience
- Utilization Management and/or Case Management experience
- Certified Case Manager (CCM)
- Working with Milliman Guidelines
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.
