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This position is an office-based position and can be located in Jackson, MS. Position is responsible for utilization management, utilization review, or concurrent review (telephonic inpatient care management). You will work with area hospitals to review patient cases while ensuring the best care for our valued members.. Generally work is self-directed and not prescribed.
Utilization Management Nurse responsibilities include:
Perform utilization and concurrent review using Milliman criteria
Conduct clinical chart assessments
Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care
Identify and evaluate delays in care
Initiate a discharge planning and readmission prevention plan when applicable
Approve bed days for inpatient cases when applicable
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
Maintain appropriate documentation
Consult with the Medical Director as needed to troubleshoot difficult or complex cases
Participate in telephonic and in-person staff meetings
After one year, the incumbent may have the eligibility to telecommute.
UnitedHealthcare Community & State 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.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier...