Preservice Review Nurse RN - Utilization Management Nurse - Richmond Virginia

Unitedhealth Group Inc. Richmond , VA 23234

Posted 3 months ago

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

If you are located in Richmond, Virginia, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Intake of provider, care coordinator, and Continuity of Care HCBS (home and community-based service) authorization requests and Nursing Facility service registrations

  • Review and processing of all HCBS service authorization requests

  • Engagement with providers and initiation/follow-up on requests for information

  • Engagement with the National Letters Team to complete mailing of member and provider notification of decision

  • Consistent application of criteria for review and approval of provider authorization requests

  • Engagement/follow-up with Medical Director to provide clinical information needed for review and application of clinical criteria

  • Engagement/follow-up with Care Coordinators for assessment of member care needs

  • Candidate should be a patient advocate, and have tenacity for finding solutions

  • Candidate should have extensive knowledge of the continuum of care

  • Candidate should conduct themselves in a professional manner at all times

Required Qualifications:

  • Virginia Registered/Licensed Nurse; licensure must be unrestricted in the state of Virginia

  • 2-5 years of clinical experience in health care clinical settings

  • 2 years working in a managed care setting

  • Experience working with Microsoft Office Suite programs (Word, Excel, Outlook)

Preferred Qualifications:

  • Direct experience working with HCBS authorizations and communicating with HCBS providers

  • Broad knowledge of the Virginia Medicaid and/or CCC Plus program including coverage and benefits

  • Utilization Management experience, including experience working with InterQual Criteria and/or Milliman Care guidelines

  • Experience working with Community Care, Facets, and ICUE programs

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.SM

  • All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

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.

Job Keywords: RN, Registered Nurse, Preservice Review, Millman, InterQual, managed care, telephonic, HCBS, service, authorization requests, community based, Utilization Management experience, word, excel, outlook, Virginia, VA, Richmond, telecommute, telecommuting, telecommuter


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Preservice Review Nurse RN - Utilization Management Nurse - Richmond Virginia

Unitedhealth Group Inc.