Job details
Job type full-time
Full job description
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you getLeading edge technology in an industry that`s improving the lives of millionsHere, innovation isn`t about another gadget, it`s about making health care data available wherever and whenever people need it, safely and reliablyThere`s no room for errorJoin us and start doing your life`s best work.(sm)
At optum, the mission is clear: help people live heathier lives and help make the health system work better for everyoneLhi is one of four businesses under optumserveOptumserve provides health care services and proven expertise to help federal government agencies modernize the u.sHealth system and improve the health and well-being of americansBy joining optumserve you are part of the family of companies that make unitedhealth group a leader across most major segments in the u.sHealth care system.
Lhi was founded in 1999 and acquired by optum in 2011Lhi specializes in creating and managing health care programs through on-location services, patient-specific in-clinic appointments, telehealth assessments, or any combination based on customer needLhi`s customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the u.sDepartments of defense, veterans affairs, and health and human services.
There`s an energy and excitement here, a shared mission to improve the lives of others as well as our own.
As a rn case manager, float , you can assess and coordinate care for a very diverse population of members of the world trade center (wtc) health program throughout the united statesThis is a multifaceted role that is highly rewarding as your work is helping people live healthier lives.
You’ll enjoy the flexibility to telecommute* from anywhere within the u.sAs you take on some tough challenges.
The primary hours for this position are monday - friday, 8am - 5pm in the local time zoneCandidates must have the ability to flex hours as needed to accommodate overall business hours of 8am to 5pm in each time zone.
A compact rn license is strongly preferred.
Primary responsibilities:
Educate and inform members of program coverage and limitations while ensuring that high quality and cost-effective care is provided within contract requirements
Use critical thinking and problem-solving skills to navigate through the complexities of a member’s health conditions while maintaining coverage within the program guidelines
Coordinate health care services for members
Prepare and summarize medical history information on members to present to the medical director
Cultivate relationships with members, providers, co-workers, and other team members to ensure program compliance and member satisfaction
Manage inbound and outbound calls from providers to prior authorize tests and procedures related to members’ certified health conditions and program coverage
Review medical records (monitoring, treatment and supportive) to determine wtc relatedness for potential program coverage and communicate results to members
Complete system-generated tasks, including documenting all results as required in internal database (mednet)
Prepare comprehensive reviews and summaries for medical appeals, determination of coverages, and requests for treatment services
Point of contact for internal departments to answer questions relative to members of their assigned caseload
Complete medical health questionnaires
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:
Active, unrestricted rn license in the state of residence
3+ years of clinical experience as a registered nurse
2+ years of utilization management experience, including prior authorizations, at an insurance or managed care company
Experience with microsoft office programs including ms word and ms outlook
Equivalent combination of education, experience and/or applicable military experience will be considered
Preferred qualifications:
Compact rn license
Case management experience
Behavioral health, occupational health, or medical/surgical background
Military healthcare experience
Medical call center experience or medical related experience in a corporate/business setting
Knowledge of icd and cpt coding
Urac / iso experience / knowledge
National career readiness certificate
Effective interpersonal, communication, and problem-solving skills
Ability to work independently as well as on a team
Demonstrated organizational and multi-tasking abilities
Solid telephone communication skills
Ability to implement critical thinking and decision-making skills to identify appropriate care/treatment plans for a wide range of members from low to high complexity
Ability to take initiative and be detail-orientated
Careers with optumHere`s the ideaWe built an entire organization around one giant objective; make health care work better for everyoneSo 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 serveOptum, 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 potentialFor you, that means working on high performance teams against sophisticated challenges that matterOptum, incredible ideas in one incredible company and a singular opportunity to do your life`s best work.(sm)
Colorado residents only: the hourly range for colorado residents is $25.63 to $45.72Pay is based on several factors including but not limited to education, work experience, certifications, etcIn addition to your salary, unitedhealth group offers 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 unitedhealth group, you’ll find a far-reaching choice of benefits and incentives.
*all telecommuters will be required to adhere to unitedhealth group’s telecommuter policy.
Diversity creates a healthier atmosphere: optumcare and its affiliated medical practices are equal employment opportunity/affirmative action employers 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.
Optumcare and its affiliated medical practices is a drug-free workplaceCandidates are required to pass a drug test before beginning employment.
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