Inpatient Case Manager

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 youre 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.

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

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

* Unrestricted RN license required in NJ *  Minimum 2+  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-NJ-Newark

Organization New Jersey

Schedule Full-time

Number of Openings 1

Please refer to job code 1247928 when responding to this ad.

Category:	Healthcare/Social Services
	> Behavioral/Mental Health
Location:	Newark, NJ
County:	Essex County
ZIP Code:	07101
Pay Rate:	Open
Job Terms:	full time
Company:	UnitedHealth Group
Phone:	email only please
Fax:	email only please