Utilization Management Nurse (RN) - TennCare

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Company:
 
UnitedHealth Group
Company Profile | Current Opportunities (39)
Job Location(s): Brentwood
Employment Term: Regular
Employment TypeFull Time
Start Date:As soon as possible
Starting Salary Range:Not Provided
Required Education: Associate Degree
Required Experience: Open
Related Categories:Healthcare - Pharmacy/Laboratory, Healthcare - Assistants/Aides/CNAs

Position Description

Utilization Management Nurse (RN) - TennCare-333099
Description
We are in search of a seasoned Registered Nurse with strong communication skills to join our TennCare team. In this phone-based role, you will work with area hospitals to review patient cases while ensuring the best care for our valued members.
This position will be office-based in Brentwood, TN and does have the potential to become work-at-home based on business need.
Primary responsibilities include:
  • Work with hospitals in Middle TN to review member cases
  • Conduct inpatient clinical review and discharge planning
  • Interact with facility-based case managers, as well as internal UHG case managers and Medical Directors
  • Coordinate homecare, durable medical equipment (DME) etc
  • Monitor length of stay by attending required rounds with the Medical Director
  • Track and trend catastrophic cases and other trends
AmeriChoice 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.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Qualifications
Minimum Qualifications:
  • RN with a current, unrestricted license in the state of TN, or ability to obtain through reciprocity
  • Minimum 3 years' clinical experience within the hospital environment
  • Solid computer skills are a must, including the ability to navigate a Windows environment
Desired Qualifications:
  • Discharge planning experience
  • 1 or more years' utilization review and/or case management experience
  • Familiarity with Milliman and/or Interqual criteria
  • Familiarity with Medicare/Medicaid
  • Proficiency with MS Excel
  • An Associates or higher-level degree
Diversity creates a healthier atmosphere: 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.
Job Clinical Utilization Managemen
Primary LocationUS-TN-Brentwood
Organization AMC Regional ICCT - Southeast
Schedule Full-time
Number of Openings 2

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