Utilization Management Specialist RN
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.
Utilization Management Nurse responsibilities include:
-Perform utilization and concurrent review using Milliman criteria
-Conduct clinical chart assessments
-Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care
-Identify and evaluate delays in care
-Initiate a discharge planning and readmission prevention plan when applicable
-Approve bed days for inpatient cases when applicable
-Arrange alternative care services; Contact and maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum
-Gather clinical information to assess and expedite care needs
-Maintain appropriate documentation
-Consult with the Medical Director as needed to troubleshoot difficult or complex cases
-Participate in telephonic and in-person staff meetings
Requirements
-A current, unrestricted RN license in state of New Mexico
-Minimum of 3 years experience including clinical experience in an inpatient/acute setting
-Proficient level of experience with Microsoft Word, Outlook and Internet Explorer, with the ability to navigate a Windows environment
Preferred Assets
-Experience in acute long term care, acute rehabilitation, or skilled nursing facilities is desired
-Experience in discharge planning and/or chart review is desired
-A background that involves utilization review for an insurance company or in a managed care environment is desired
-Familiarity with Milliman criteria guidelines would be helpful
-Case management certification and/or experience is preferred
-Ability to build and maintain relationships will be essential
-A Bachelor�s degree is preferred
UnitedHealthcare Community State 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 UnitedHealthcare Community State.
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.
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.
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.
