Onsite Utilization Management Nurse, RN - Greensboro, NC - (US-NC-Greensboro - 27499)

Minimum Education: None
Jobcode: 60144385
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UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
 
When you work with UnitedHealthcare, what you do matters. It's that simple…and it's that challenging.
 
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
 
The Utilization Management Nurse is responsible for utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). The UM Nurse will performs reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescribed.  The Utilization Management Nurse works under the direct supervision of an RN or MD.
 
Primary responsibilities:

• Assesses and interprets customer needs and requirements


• Identifies solutions to non-standard requests and problems


• Solves moderately complex problems and/or conducts moderately complex analyses


• Works with minimal guidance; seeks guidance on only the most complex tasks


• Translates concepts into practice


• Provides explanations and information to others on difficult issues


• Coaches, provides feedback, and guides others


• Acts as a resource for others with less experience

• Unrestricted RN license required in your state of residence


• 2 yrs Managed Care and/or Clinical experience required

• Pre-authorization experience preferred


• Case Management experience preferred


• Certified Case Manager (CCM)


• Undergraduate degree or equivalent experience.