Job Details: Utilization Review RN - Office-based role w/great hours

Company: UnitedHealth Group – UnitedHealth Group, a Fortune 50 company, is an innovative leader in the health and well-being industry, serving approximately 70 million Americans. Learn more at www.unitedhealthgroup.com/careers

Description: Nice change from direct care and great Monday through Friday hours!
At UnitedHealth Group, we are a healthy business in more ways than one. We are a Fortune 50 company identified as the first or second most admired company in the health care industry by rankings published in Fortune magazine since 1995. We also have the privilege each day - directly or indirectly - to make a significant difference in someone's life. Sound like a rare combination? It is. Join us and you'll be inspired to discover your own mix of professional advantages and personal rewards.

If you're interested in bringing your clinical nursing skills to a position that offers a nice change from direct care and plenty of autonomy, apply to join us as an Utilization Review RN in either our Moline, IL or Urbandale, IA office. The chosen RN will provide telephonic inpatient utilization review and moderate to complex care management to ensure that our patients receive the best and most appropriate care possible. If you are ready to experience all the excellent benefits and advancement potential that only a well-respected Fortune 50 Company can offer, we invite you to apply today.

Primary responsibilities of the Utilization Review RN would include:
Performing care management activities to ensure that patients move through the continuum of care efficiently and safely
Reviewing cases and analyzing clinical information in conjunction with Physician Advisors and Medical Directors to determine the appropriateness of hospitalization
Escalating cases to the Medical Director for case discussion or peer-to-peer intervention as appropriate
Performing anticipatory discharge planning in accordance with the patient's benefits and available alternative resources
Referring patients to disease management or case management programs
Assisting with the development of treatment plans
Documenting activities according to established standards

Qualifications
Required qualifications include:
A current, unrestricted RN license
Clinical nursing experience gained in a hospital setting
Ability to communicate effectively with physicians and hospital personnel
Basic computer skills and the ability to type while speaking on the phone
In addition, ideal assets include:
A background in managed care
Experience in discharge planning
Acute care experience
Familiarity with DoL, NCQA, HIPAA and Medicare requirements
An understanding of Milliman or other evidence-based criteria
Case management certification
Excel skills

UnitedHealth Group offers a full range of comprehensive benefits to full-time and part-time employees, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.

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

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.
Please apply online!

Posting Date: May 1 08