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UnitedHealthcare has an outstanding opportunity available for a field-based On Site Utilization Management Nurse in Honolulu, HI. In this rewarding and challenging role, the successful candidate will be responsible for utilization management and review of inpatient stays for Medicare and Medicaid recipients. The UM Nurse performs on site reviews of current Acute Inpatient Services and determines medical appropriateness of those services following an evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescribed. The On Site Utilization Management RN works under the direct supervision of an RN or MD.
Field-based/telecommuting opportunity, but interested applicants must be available to attend weely meetings in our Honolulu office.
- Provides authorizations and/or denials based on clinical documentation review and medical necessity.
- Collects patient utilization data on site at local facilities and via fax and e-mail
- Collaborates closely with the Medical Director for complex cases.
- Develops expertise in a managed care plan Utilization Management process.
- Identifies solutions to non-standard requests and problems.
- Solves moderately complex problems and/or conducts moderately complex analyses.
- Provides explanations and information to others on difficult issues
Job Keywords: RN, Registered Nurse, Nursing, Honolulu, Case Manager, Case Management
- Current and unrestricted RN license for the State of Hawaii
- Minimum 3 years of acute care or case management experience
- Demonstrated computer proficiency in a Windows environment
- Current and unrestricted driver's license and proof of auto insurance
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.
- Strong knowledge of Medicaid and Medicare plans
- Experience working in utilization management is highly preferred
- Discharge planning experience
- Experience working with Milliman and/or Interqual
When you work with UnitedHealthcare , what you do matters. Itâ€™s that simpleâ€¦and itâ€™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.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth 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.
When you work to better people’s lives, one of those lives will always be yours.
We have modest goals: Improve the lives of...