Utilization Management Nurse RN – CA - Full-time / Part-time

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.  This is an inspiring job at a truly inspired organization. Ready for a new path? Join us and start doing your life's best work.(sm)
 
UnitedHealthcare has an excellent opportunity available for a California licensed RN to work from home anywhere in the state.  In this Concurrent Review role, the successful candidate will be assigned to multiple hospital facilities. Want to learn more before applying for this role?
 
*Must Reside in the state of California*
 
Primary Responsibilities:

Facilitates complex discharge planning activities
Discharge medication reconciliation as it pertains to formulary overrides
DME
Home or OP Infusions, Wound Clinics, OP Services, Home Health/Hospice
Confirms post discharge MD appointments
Complex facility to facility
Coordination / transfers - AIR, LTACH, SNF
Communicates to ICM through system
Notes or verbal discussions regularly
Contacts member, caregiver or member's family to discuss discharge evaluation and post discharge plan
Collaborates with facility case manager, physicians, specialists, vendors
Participates in family conferences with facility team as necessary
Ensures discharge follow up appointment with PCP, Specialist, Medical Home
Documents interventions and activities in applicable clinical core system
Obtains necessary Prior Authorizations related to discharge plan
Handles denials based on services requested, as appropriate
Generates any applicable letters
Analyzes and resolves complex problems related to discharge planning and escalate as appropriate
Coordinates with ICM to ensure appropriate hand off to Transitional Care/Case
Management (OPTUM)
Tracks and reports discharge planning cases in DCP Tracking Log
 

Required Qualifications:

Unrestricted RN license required in state of residence
Ability to create, edit, save and send documents utilizing Microsoft Word. Ability to navigate a Windows environment
Hospital Acute Case management 3 years
Preferred Qualifications:

Prior Authorization Experience
Able to analyze and resolve complex problems
 
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
 
 
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: California, CA, Telecommute, Telecommuting, Telecommuting, Prior authorization, Case Management, Home Health, Utilization Management Nurse, RN