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. Will work On-site at: 795 Woodlands Parkway, Suite 301 Ridgeland MS 39157. Up to 25% travel required. Primary Responsibilities: Ongoing Monitoring, tracking, trending and reporting of Utilization Inpatient and Outpatient Service Patterns Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination Perform utilization management, utilization review, or concurrent review (on-site or telephonic Care coordination) Assess and identify customer specific and / or population needs to develop a plan of action Resolve non-standard requests and problems Work with minimal guidance; seeks guidance on only the most complex tasks Translate concepts into practice Serve as a subject matter expert to provide explanations and information to others on utilization related issues Facilitate care coordination to impact utilization management activity across clinical and multi-disciplinary care teams Update and maintain utilization management policies and procedures, including program evaluation and reports for internal quality committees Contribute to audit requests and request for proposals Responsible for provider education related to UM processes Research, review and respond to general inquiries that demonstrates clear, concise and proficient writing skills Lead initiatives as delegated to ensure proper implementation and generate outcome summary and / or report
Required Qualifications:Unrestricted RN license required in state of residence 2 or more years of Managed Care or Care Management experience 2 or more years of clinical experience Ability to create, edit, save and send documents utilizing Microsoft Word, PowerPoint and Excel 1 or more years of public speaking Ability to communicate in writing using proficient grammar Ability to navigate a Windows environmentPreferred Qualifications:Pre-authorization experience Utilization Management experience Case Management experience Knowledge of Milliman Criteria Certified Case Manager (CCM) Undergraduate degree Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high - risk pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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: Registered Nurse, Utilization RN, Registered Nurse, Preauthorization, clinical, Managed Care, Certified Case manager, Pre-authorization, Milliman Criteria, Ridgeland, MS, Mississippi
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.