Utilization Management Nurse - Honolulu, HI
Location: Honolulu Hawaii
Description: UnitedHealth Group is in need of Utilization Management Nurse - Honolulu, HI right now, this vacancy will be placed in Hawaii. For complete informations about this vacancy opportunity kindly see the descriptions. There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handf! ul of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
Get better informed to determine your fit into this position. Click here to view the Realistic Job Preview: Onsite_UM_Nurse.pdf
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 meetin! gs in our Honolulu office.
Primary Responsibilities:
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
Requirements
Requirements:
Current and unrestricted RN license for the State of Hawaii
Minimum 3 years of acute care or case management experience
Demonstrated computer proficienc! y in a Windows environment
Current and unrestricted driver's license and proof of auto insurance
Desired Assets
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
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.
When you work with UnitedHealthcare , what you do matters. It’s that simple…and it’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 atmosphe! re: 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.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to UnitedHealth Group.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Wed, 29 May 2013 22:25:09 GMT
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