Southwest Medical Associates (SMA) is a multi-specialty group of physicians, Nurse Practitioners and Physician Assistants, consisting of over 200 providers, fourteen clinical locations including nine health care centers, five urgent care clinical and an outpatient surgery center. SMA offers patients compassion, innovation, and quality care throughout southern Nevada. SMA is headquartered in the greater Las Vegas, NV area.
Let’s face it, no industry is moving faster than health care. And no organization is better positioned to lead health care forward than UnitedHealthcare, part of the UnitedHealth Group family of businesses. In this role, you’ll discuss cases with treating physicians and other health care professionals to ensure our members receive the proper health services. You’ll also stay in touch with acute long-term care, acute rehabilitation or skilled nursing facilities to help patients through their care plan. It’s an exciting opportunity to bring your skills to a truly inspired organization.
- Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language and consideration of relevant clinical information
- Communicate all types of benefit determinations, including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations
- Speak to health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
- Act as a resource for others with less experience
- Current, unrestricted NV RN license or temporary NV RN license with the ability to obtain permanent NV RN license upon expiration of temporary NV RN license
- 3+ RN years of experience, including experience in an inpatient / acute setting
- Bachelor’s Degree (BSN)
- Background involving utilization review for an insurance company or experience in case management
- Familiarity with Milliman Care Guidelines
Use your diverse knowledge and experience to make health care work better for our patients. Join us in reshaping health care while doing your life’s best work.(sm)
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.
Key words: RN, Nurse, Preservice, Prior Authorization, Pre-Service, UM, UR, Clinical Review, Clinical Coverage, Utilization Management, Utilization Review, Case Manager, Case Management, LTC, Long Term Care, Medicaid, Milliman, MCG, InterQual, UHG, UnitedHealth Group, UHC, UnitedHealthcare