Energize your career with one of Healthcare’s fastest growing companies.
You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
At UnitedHealth Group we want the health system to work better for everyone. Join us and you'll be part of a team that's focused on transformational change. As a Case Manager, you'll help provide a holistic, patient - centered approach to care that addresses both immediate and long - term needs. And you'll open doors for yourself that simply do not exist in any other organization, anywhere. Join us and feel proud knowing you're empowered to help people live healthier lives.
- Responsible for providing telephonic medical case management for the Auto TCM Department
- Review treatments plans based on causality and medical necessity
- Ensure accuracy, quality and timeliness of reviews are in accordance with NJ regulations and departmental policy and procedures and account protocols
- Ensure all notices are accurate and processed timely in accordance with NJ regulations and departmental policy and procedures and account protocols
- Review and evaluate all medical correspondence received
- Identify properly submitted treatment plans that quality for authorization are processed in accordance with NJ regulations and departmental policy and procedures and account protocols
- Identify properly submitted treatment plans that quality for a Medical Director Review (MDR) are processed in accordance with NJ regulations and departmental policy and procedures and account protocols
- Identify properly submitted treatment plans that quality for TCM Negotiation are processed in accordance with NJ regulations and departmental policy and procedures and account protocols
- Identify and recommend Independent Medical Examinations (IMEs), Retrospective Peer Reviews, and referrals to Field Based Case Management (FBCM) as necessary and in accordance with NJ regulations and departmental policy and procedures and account protocols
- Identify approved services appropriate for referral to Cypress Care according to account specific protocols and properly completes the referral according to departmental policy and procedures and account protocols
- Review the claim treatment history with internal and external contacts in accordance with NJ regulations and departmental policy and procedures and account protocols
- Evaluate clinical file and ensures treatment is causally related and medically necessary
- Adhere to cost savings measures and departmental and company - wide Quality Assurance programs
- Hold to the philosophy and standards of quality as outlined by Procura Management Inc.
- Adhere to statutory regulations, HIPPA compliance, account protocols and department policy and procedures
- Generate and process all AIMS correspondence in accordance with NJ regulations and departmental policy and procedures and proofreads to ensure accuracy
- Prepare comprehensive summaries following determinations or after significant activity occurs on the file in accordance with departmental policy and procedures and account protocols
- Maintain the integrity of RMS system at all times and adheres to all electronic paperless workflows
- Attend in - service meetings and continuing education seminars as appropriate
- May act as preceptor for TCMs as directed by management
- Perform other AIMS Department duties as assigned
- High School Diploma / GED (or higher)
- Valid LPN License for the State of PA or recognized by the State of PA
- Experience creating, editing, saving and sending documents using Microsoft Word, Microsoft Excel, and Microsoft Outlook
- 2+ years of related case management experience
- Understanding of NJ, PA regulations, managed care, and insurance terminology
- Excellent communication, interpersonal and organizational skills
- Professional phone etiquette
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.
If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Keywords: case manager, case management, medical case manager, RN, LPN, Norristown, PA, Pennsylvania