Utilization Management Nurse RN - Tonawanda at Tonawanda

Job Description

Want to learn more before applying for this role? Click here to view the Realistic Job Preview: UHC_Telephonic_UM_Nurse.pdfUtilization Management Review Nurse responsibilities include:Perform utilization management and utilization review (telephonicprospective care management)Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determinationAssess and interpret customer needs and requirementsIdentify solutions to non-standard requests and problemsWork with minimal guidance; seeks guidance on only the most complex tasksTranslate concepts into practiceProvide explanations and information to others on difficult issuesCoach, provide feedback, and guide othersAct as a resource for others with less experienceUnitedHealthcare, 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, were 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.

Job Requirements

Requirments: Unrestricted RN license required in state of NY5 years Clinical RN experience Basic level of experience with Microsoft Word, with the ability to navigate a Windows environmentAdditional Assets Preferred:Psychiatry Experience Prospective Review ExperiencePre-authorization experience highly preferredUndergraduate degreeCase ManagementDiversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Country: USA, State: New York, City: Tonawanda, Company: UnitedHealth Group.