If you want to achieve more in your mission of health care, you
have to be really smart about the business of health care. Challenge yourself,
your peers and our industry by shaping what health care looks like and doing your
life's best work.SM
In this position Utilization Management Review Nurse - RN (Per
Diem) - Melville, NY, you will be assisting with Denial Prevention.
Responsibilities include doing initial reviews on urgent admissions and
upgrades, sending reviews to insurance carriers and validating the need for
Work days will fluctuate based on business needs.
- Performs initial concurrent utilization management reviews using MCG/Allscripts criteria.
- Conducts clinical chart review for appropriateness of admission and continued length of stay.
- Contacts and interacts with third party payers as needed to obtain approval of hospital days
- Ensures compliance with current state, federal, and third party payer regulations.
- Identifies patients for Observation level of care and notifies appropriate health team members.
- Communicates with insurance companies and physicians regarding utilization issues.
- Ensures managed care reviews are up to date and accurately reflect patient’s clinical progress and acute needs.
- Performs related duties, as required.
- Utilizes Allscripts, Sunrise, Word and Outlook.
- Unrestricted RN license in the state of NY
- High School Diploma / GED or higher
- Must have an active RN license for the state of New York
- 3+ years as an RN in a clinical setting
- Proficient in Microsoft Word (creating and editing documents) and Outlook (calendar and email)
- Must have a flexible schedule and the ability to work Monday to Sunday on as needed basis – per diem.
- 1+ years experience as a RN in Case Management or Quality Assurance setting
- Experience with Allscripts (for clinical review of chart) and/or Sunrise (clinical application for electronic medical records)
Careers with Optum. Here's the idea. We built an
entire organization around one giant objective; make health care work better for
everyone. So when it comes to how we use the world's large accumulation of
health - related information, or guide health and lifestyle choices or manage
pharmacy benefits for millions, our first goal is to leap beyond the status quo
and uncover new ways to serve. Optum, part of the UnitedHealth Group
family of businesses, brings together some of the greatest minds and most
advanced ideas on where health care has to go in order to reach its fullest
potential. For you, that means working on high performance teams against
sophisticated challenges that matter. Optum, incredible ideas in one
incredible company and a singular opportunity to do 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.
Keywords: UnitedHealth Group, Optum, RN,
Per Diem, Melville, New York, Case Management, Healthcare, RN