There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. A passion for excellence you won't find anywhere else. We ask tough questions. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work.(sm) As a Continuity of Care Nurse RN, you will drive positive outcomes by supporting a diverse member population with education, advocacy and the connections to the resources they need. What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Primary Responsibilities: Make outbound calls to members and providers to assist new enrollees with continuity of care needs Set up authorizations for continuity of care for new enrollees Assist with authorizations on member issues, provider claims issues and state concerns Interact with Medical Directors on challenging cases Make referrals to internal resources as needed (case management, behavioral health, etc.) Document and track findings Attend community meetings as needed Support Health Services Department with special projects as needed Support Provider Advocates with provider claims research and authorizations as needed Support the Private Duty Nursing/Medically Intensive Children's Program case management and service authorization
Required Qualifications:Current, unrestricted RN license in the State 2+ years' experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company Ability to navigate a Windows environment, utilize Outlook and the ability to create, edit, save and send documents utilizing Microsoft Word and ExcelPreferred Qualifications:Bachelor's Degree A background in managed care Case Management experience Certified Case Manager (CCM) Experience / exposure with discharge planning Experience in utilization review, concurrent review and / or risk management Strong organizational skills and multitasking abilities will be keys to successCareers 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) 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: Case Manager, Care Manager, RN, Registered Nurse, Medicaid, CCM, Spokane, WA, Washington
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.