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Inpatient Care Utilization Management - Denver Metro
| Hours | Full-time, Part-time |
|---|---|
| Location | Denver, CO Denver, Colorado |
About this job
There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
The Utilization Management Nurse is responsible for utilization management, utilization review, or concurrent review for Onsite Inpatient Care Management. The UM Nurse will perform reviews of current inpatient services, and determine medical appropriateness of inpatient services for Denver metro, New Mexico, etc which includes following evaluation of medical guidelines and benefit determination.
***This is a telephonic telecommuter position; candidate must be flexible to working onsite at hospitals within the Denver Metro area when needed***
Primary Responsibilities:
- Performs reviews of current inpatient services.
- Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
- 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
- Provide explanations and information to others on difficult issues
- Coach, provide feedback, and guide others
- Act as a resource for others with less experience
Requirements
Required:
- Must have a Colorado Compact RN license
- Must have a reliable vehicle, a current and unrestricted CO driver's license and proof of auto insurance
- 2 yrs of hands on clinical experience
- Strong communication skills, written and verbal
- Strong organizational skills
- Advamced computer skills;must be able to type and talk, in addition to navigating around a Windows environment
Preferred:
- 2 yrs of Utilization Management experience
- Bachelors Degree
- Milliman experience
- Managed Care experience
- Adult acute care experience in a hospital setting
- Case Management experience
- BSN
- Previous Onsite UM experience
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.
Key Word: RN, Registered Nurse, Nurse, UR, Utilization review, UM, Utilization Management, Compact license, Denver, CO, Colorado