Description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

If you are located in Las Vegas, NV, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Complete IQ Initial Utilization review process within 24-48 hours of notification to the health plan in ICM under COC Inpatient Utilization Review Note
• Complete IQ Concurrent Utilization review process within 72 hours of notification to the health plan in ICM under COC inpatient Utilization Review Note
• Update bed day coding daily
• Complete any Variances as directed by the Health Plan Medical Directors/Managers
• Variances include: Delay of Service, Administrative Adverse Determinations, Medical Necessity Adverse
• Determinations, Missed Opportunity, Quality of Care incident reports, & Hospital Acquired Condition assessments
• May need to cross cover other facilities for UM functions & May need to physically float to other hospitals
• Assess members for discharge planning & Social Determinates of Health needs within 24 hours of notification
• Complete Discharge Planning Assessment note in ICM within 24 hours of notification to Health plan of admission
• Complete Medicaid PCP Assessment note in collaboration with the CAC within 3 attempts
• Collaborate with the member, attending physician and hospital staff to ensure the member discharges to the most appropriate level of care and needs are met for discharge planning
• Coordinate discharge disposition needs (SNF, LTAC, AIR, HHC, & DME)
• Ensure the CAC is aware of all Transitions of Care referral needs through tasking and appropriate communication
• Collaborate with the Behavioral Health department, Nevada Behavioral Health and community health care workers for member's identified with Behavioral Health needs
• Complete Discharge Planning Note within 48 hours of member being discharged from the acute inpatient hospital facility
• Physically round at hospital facilities (Face to Face) with the members daily and collaborate with facility stakeholders
• Attended Hospital UM Management Rounds
• Serves as a resource for inpatient case managers
• Anticipate customer needs and proactively develops solutions to meet them
• Serves as a key resource on complex and/or critical issues
• Solves complex problems and develops innovative solutions
• Reviews work performed by others and provides recommendations for improvement
• Forecasts and plans resource requirements
• Provides explanations and information to others on the most complex issues
• Motivates and inspires other team members
• Leads as a preceptor to prepare nurses for the care coordination and utilization management roles

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Unrestricted RN license
• Managed Care experience (Previous Quality review experience preferred)

Preferred Qualifications:

• BSN or MSN

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $34.23 to $61.15 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.