Positions in this function include RN (with current licensure) roles that work under the direct supervision of an RN or MD. Function is responsible for utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). Performs reviews of current inpatient services. Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.

Requirements:

·         A current, unrestricted RN license in state of residence

·         Minimum of 3 years experience including clinical experience in an inpatient/acute setting

·         Basic level of experience with Microsoft Word, Outlook and Internet Explorer, with the ability to navigate a Windows environment

Preferred Assets:

·         Experience in discharge planning and/or chart review

·         A background that involves utilization review for an insurance company or in a managed care environment

·         Familiarity with Milliman criteria guidelines 

·         Case management certification and/or experience

·         Ability to build and maintain relationships will be essential

·         A Bachelor's degree is preferred

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:
UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.