Telephonic Utilization Management RN - Trumbull, CT

Nursing careers with UnitedHealth Group. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. And here at UnitedHealthcare Employer & Individual, a thriving part of the UnitedHealth Group family of companies, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)

Telephonic Utilization Management Nurse - UnitedHealthcare Employer & Individual
There are so many incredible reasons to choose a career with UnitedHealth Group, but the most important things you need to know are, that in this role, you will:

• Work with hospital staff, via telephone, fax and e-mail, in the coordination of care for members ranging from low acuity to catastrophic, which may include stays of several months


• Help coordinate appropriate care to members from admittance to discharge, and work toward holistic discharge, all with the members' benefits plan in mind


• Perform telephonic medical records review for Commercial and Medicare members, and telephonic follow-up with members as required


• Balance metrics/goals (bed days, treatment and discharge) with a focus on quality care for members


• Complete electronic documentation daily to ensure essential data is shared system-wide


• Maintain flexibility and willingness to go above and beyond to meet members' needs

Work Monday - Friday Days in the Trumbull, CT office!

As a Telephonic Utilization Management Nurse with UnitedHealthcare Employer & Individual, sometimes referred to as an Inpatient Care Manager, you'll follow member cases and impact members' quality of care at every touch point along their inpatient stay. Ever-mindful of matching member needs with appropriate levels of care, you'll also focus on metrics/goals, such as managing bed days. Working to achieve discharge with member benefits in mind, you'll also provide referrals for Transitional Case Management nurses or Disease Management nurses that serve as a connection to proper outpatient and/or home based care. The result? Enhanced system efficiency and performance, balanced
with optimal regard and respect for the care we provide to members.

Required Qualifications:

• Active, unrestricted RN license in the state of Connecticut


• 3+ years of acute care experience


• Basic knowledge of MicroSoft Word

Preferred Qualifications:

• Experience in acute long term care, acute rehabilitation, or skilled nursing facilities


• Experience in discharge planning and/or chart review


• A background that involves utilization review for an insurance company or in a managed care environment


• Familiarity with MCG (Milliman) guidelines


• Case management certification and/or experience

Job key skills:
Ability to build and maintain relationships will be essential

Now is the time, and this is the place where you'll find a career in which you can make a big difference – in our company, our industry, even our world. If you're looking for something better, look no further. You have arrived.

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

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

Job Keywords: RN, Registered Nurse, BSN, Utilization Management, CMS Guidelines, Milliman,  NCD, LCD,  MCG guidelines, Trumbull, CT