Telephonic Utilization Management RN - Kingsport and Knoxville locations

• Perform telephonic utilization and concurrent review using Milliman criteria 


• Conduct clinical chart reviews 


• 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 staff meetings

• Active, unrestricted RN license in state of TN


• 3+ years' experience in medical/surgical unit, or other clinical experience in an inpatient/acute setting 


• Proficient level of experience with Microsoft Word, Excel, Outlook and Internet Explorer, with the ability to navigate a Windows environment 


• Strong communication and interpersonal skills 


• Must live within a commutable distance of Kingsport or Knoxville office locations

• BSN 


• Previous discharge planning, utilization or case management experience 


• Certified Case Manager (CCM) 


• Familiarity with Milliman Guidelines


• Knowledge of federal programs such as Medicare and management of commercial members

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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.