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in Tonawanda, NY
Preservice Review Nurse RN - Tonawanda, NY
Hours | Full-time, Part-time |
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Location | Tonawanda, NY Tonawanda, New York |
About this job
Primary Responsibilities:
- Perform utilization review using Milliman criteria
- Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care
- 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
Requirements
Required Qualifications:
- Unrestricted, active RN license in NY
- 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
Preferred Qualifications:
- Utilization management, prior authorization, and case management experience
- Working knowledge of Milliman and/or InterQual
- Undergraduate degree (BSN) or equivalent experience
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:RN, Registered Nurse, UR, UM, Pre-Authorization, Utilization Review, Utilization Management, Milliman, Interqual, Managed Care, Insurance, Case Management, Case Manager, Chart Review