Preservice Review Nurse RN

Are you ready for your next challenge? Discover it here at UnitedHealthcare and help us reinvent the health system. This can be your opportunity to take on 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. You will discuss cases with treating physicians and other healthcare professionals to ensure our members receive the proper health services. You will be required to maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities in order to help patients through their care plan. This is an exciting opportunity at a truly inspired organization. Join us. This can be the start of your life's best work.(sm)
What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
 
Primary Responsibilities:

Perform utilization and concurrent review using MCG and CMS criteria
Discuss cases with treating physicians and other healthcare professionals to better understand plans - of - care
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
Consult with the Medical Director as needed to troubleshoot difficult or complex cases

Required Qualifications:

Unrestricted, active RN license
3 years RN experience in an acute setting
Ability to create, edit, save and send documents utilizing Microsoft Word. Ability to navigate a Windows environment, Microsoft Outlook, and conduct Internet searches
Knowledge of utilization review process and prior authorization process in a managed health care industry
Knowledge of ICD10 and CPT coding
Knowledge of MCG  Guidelines
Detail oriented, self - sufficient and decisive
Excellent organizational skills, written and oral communication skills
Sound decision making ability
Ability to work well under pressure
Computer proficiency
Preferred Qualifications:

Utilization management, prior authorization, and case management experience
Working knowledge of MCG
Undergraduate degree (BSN) or equivalent experience
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
 
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and 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: Preservice RN, RN, MCG, CMS, Phoenix, Arizona, AZ
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