Utilization Mgmt Nurse - Rockville MD

UnitedHealthcare 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.

When you work with UnitedHealthcare, what you do matters. Its that simple• and its that challenging.

In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.  This position may eventually work from home, but will initially be located in the Rockville, MD office.  To be considered you must live within a commutable distance of the Rockville office.

Position Summary:

The Utilization Management Nurse is responsible for utilization management, utilization review, or concurrent review (telephonic inpatient care management). The UM Nurse will performs reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescribed.  The Utilization Management Nurse works under the direct supervision of an RN or MD.

Primary responsibilities:

* Assesses and interprets customer needs and requirements * Identifies solutions to non-standard requests and problems * Solves moderately complex problems and/or conducts moderately complex analyses * Works with minimal guidance; seeks guidance on only the most complex tasks * Translates concepts into practice * Provides explanations and information to others on difficult issues * Coaches, provides feedback, and guides others * Acts as a resource for others with less experience

Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.

Qualifications

Qualifications:

* Unrestricted RN license required in your state of residence * Minimum 2-3 years Med-Surg experience. * 2 yrs Managed Care experience preferred * Strong experience with Milliman Criteria * Strong communication and organization skills

Additional Assets Preferred:

* Pre-authorization experience preferred * Case Management experience preferred * Certified Case Manager (CCM) * Undergraduate degree or equivalent experience.

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 Location US-MD-Rockville

Organization UHC HS Clinical Operations

Schedule Full-time

Number of Openings 1

Please refer to job code 1250093 when responding to this ad.

Category:	Healthcare/Social Services
	> Registered Nurse (RN)
Location:	Rockville, MD
County:	Montgomery County
ZIP Code:	20847
Pay Rate:	Open
Job Terms:	full time
Company:	UnitedHealth Group
Phone:	email only please
Fax:	email only please