Utilization Management Nurse Job in San Antonio 78201, Texas US
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.
Want to learn more before applying for this role? View the Realistic Job Preview to learn more aspects of this job: UHC_Telephonic_UM_Nurse.pdf
We are seeking a telephonic UM Nurse in San Antonio, TX or Cypress, CA.
The Utilization Management Nurse is responsible for utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). The UM Nurse will performs 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 include:
- 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
When you work with UnitedHealthcare Employer Individual, what you do matters. It's that simple...and it's 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.
Regardless of your role at UnitedHealthcare Employer Individual, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
Required Experience:
- Unrestricted RN license in TX or CA
- Minimum of 2 yrs of Clinical experience
Preferred Experience:
- Pre-authorization experience
- Experience with Medicare guidelines
- Knowledge of ICD9(10) and CPT codes
- Milliman Care Guidelines
- Case Management experience
- Certified Case Manager (CCM)
- Knowledge of Word, Excel, Internet and Outlook at an intermediate level highly preferred
- Undergraduate degree or equivalent experience
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.
