**Description** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. **Responsibilities** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and...

Morgan & Morgan is seeking a Full-Time Bilingual Registered Nurse (RN) or Licensed Practical Nurse (LPN). This position requires working Monday thru Friday in our busy case control center, working on the telephone and intaking medical malpractice and nursing home claims. Our ideal candidate will be able to work anytime between the hours of 8am to 8pm. Scheduling conflicts must be discussed pre-hire and will be evaluated on a case-by-case basis. Monday through Friday 8am-5pm shifts are awarded based on seniority and are not available when starting. Job Duties and Responsibilities Vetting the legal claims of prospective clientsIntaking medical malpractice and nursing home claimsHandle certain aspect of the legal intake processResolve problems and handle clients issues in a professional mannerData Entry Requirements MUST LIVE IN OR NEAR THE ORLANDO/LONGWOOD AREA Registered Nurse (RN) or Licensed Practical Nurse (LPN) Strong verbal and written communication skillsStrong listening...

Are you interested in learning about healthcare professions and the latest healthcare innovations in the KC area?Become part of an organization that is dedicated to making a difference in both your career and community.Job Description Summary : Utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote optimal, cost-effective outcomes.Candidates need to be located in the KC metro area.Job Description Completes member assessments by collecting and analyzing information across the seven domains of health and develops and implements individualized care plans with appropriate interventions in a culturally sensitive way. Uses standardized tools to complete assessments in the areas of clinical, functional, financial, support system, psychosocial and cognitive and environmental realms.Monitors effectiveness of plan of care by gathering sufficient...

DescriptionThe Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.ResponsibilitiesThe Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) You push yourself to reach higher and go further. Because for you, it's all about ensuring a positive outcome for patients. In this role, you'll work in the field and coordinate the long-term care needs for patients in the local community. And at every turn, you'll have the support of an elite and dynamic team. Join UnitedHealth Group and our family of businesses and you will use your diverse knowledge and experience to make health care work better for our patients. In this Health and Social Services Coordinator role, will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs...

Are you ready for your next challenge? Discover it here at UnitedHealthcare and help us reinvent the health system. This can be your opportunity to take on a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. You will discuss cases with treating physicians and other healthcare professionals to ensure our members receive the proper health services. You will be required to maintain communication with acute long-term care, acute rehabilitation, or skilled nursing facilities in order to help patients through their care plan. This is an exciting opportunity at a truly inspired organization. Join us. This can be the start of your life's best work.(sm) What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team...

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. 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? Start doing your life's best work.(sm) The Senior Clinical Quality Consultant (CQC) will drive consistency, efficient processes and share best practices, in a collaborative effort with the provider and large or complex groups, designed to facilitate a minimum 4 STAR quality performance. The Sr CQC will participate in quality improvement initiatives, attend monthly or joint operating committee meetings, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship. This position may serve as the team lead for the clinical quality...

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready for a new path? Join us and start doing your life's best work.(sm ) What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is...

We're making a strong connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today! The schedule for this position is Monday - Friday, 3 days per week will be 8am - 5pm and 2 days 11am - 8pm. Opportunity to telecommute / work at home after 6 months if meeting all job goals. Primary Responsibilities: Make outbound calls to assess members' current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self-management Interact with Medical Directors on challenging cases Coordinate care for members Make...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) The Clinical Practice Consultant RN will focus on tasks that occur in accordance with State, CMS or other requirements as applicable. This position will also be responsible for direction and guidance on provider-focused, clinical quality improvement and management programs. This role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools. Position reports to the Quality Leadership of the Health Plan. If...

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) The Utilization Management Manager reports to the UM Director and is responsible for the leadership of a virtual team of Nurse. We strive to provide our members with the most appropriate care, at the most appropriate time during their period of illness or injury. If you are located in the CST or EST time zone, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Oversees the Inpatient case management area Manage a team size of approximately 15 - 20 nurses Responsible for metrics of team and productivity reporting Responsible for auditing of nurses to monitor that clinical criteria guidelines are being followed Daily/weekly...

Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Discharge Care Manager at UnitedHealth Group, you will be responsible for implementing day-to-day telephonic case management interventions for identified high risk members. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Are you ready for a new path? Join us and start doing your life's best work. The Discharge Care Manager (DCM) will coordinate and document the discharge plan in collaboration with other key clinical care team members. The DCM will also follow the member while in the acute inpatient setting. If you are located in Missouri, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Evaluation of member discharge...

The OptumCare Clinical Claim Review team conducts medical necessity reviews for post-service professional claims and retro, first and second level reconsideration reviews for the medical necessity of inpatient versus observation level of care. This role is responsible for coordination, supervision and is accountable for the daily activities related to the retrospective review of medical claims and application of medical and reimbursement policies. The Optum Care Clinical Claim Review Supervisor requires the ability to efficiently move between review types as needed, with a strong knowledge of claims processing and utilization management. You'll enjoy the flexibility to telecommute* from within the U.S. as you take on some tough challenges. Primary Responsibilities: Supervise and coordinate daily work activities of the CCR team Monitor, create reports, and set priorities for the team productivity, metrics, and quality audits to ensure established standards are met Monitor...

What you do matters. And who you do it for matters even more. If you're looking for more meaningful impact, you should take a serious look at our growing organization. Since our founding in the mid-90's, Peoples Health has brought innovation and compassion to Medicare patients throughout Louisiana. Now, part of the UnitedHealth Group family of companies, our team consists of over 900 people who are experienced in all aspects of care delivery, health maintenance and administrative support. It's our goal to help guide over 60,000 Medicare recipients across the broad spectrum of health and dental services. We're committed to the highest purpose; improving lives. And that makes us the singular place to do your life's best work.(sm) The Research Nurse is responsible for receiving and researching requests for inpatient and outpatient services that cannot be otherwise approved and have been forwarded to the Medical Review Unit (MRU) for further review. If you are located in...

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm) The Specialized Clinical Programs (SCP) Case Manager will perform telephonic assessments including ongoing re-assessment, case planning, service coordination and monitoring of the services that eligible members with special needs receive. Collaborates with the member and other health care providers to facilitate member access to health and social services, foster adherence to efficient and cost-effective medical treatment regimens which enhance member's health and well-being. Facilitates a proactive partnership with members to enhance and personalize management of health-related needs. Conducts comprehensive assessment of needs, continuous care plan development, coordination and evaluation of member's services leading to the goal of equipping and empowering members and...

Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Discharge Care Manager at UnitedHealth Group, you will be responsible for implementing day-to-day telephonic case management interventions for identified high risk members. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Are you ready for a new path? Join us and start doing your life's best work. The Discharge Care Manager (DCM) will coordinate and document the discharge plan in collaboration with other key clinical care team members. The DCM will also follow the member while in the acute inpatient setting. If you are located in Kentucky, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Evaluation of member discharge needs...

At Optum , the mission is clear: Help people live heathier lives and help make the health system work better for everyone. LHI is one of 4 businesses under OptumServe . OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system. LHI was founded in 1999 and acquired by Optum in 2011, LHI 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 need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health...

Optum seeks a Clinical Quality Analyst to ensure quality and patient safety standards are adhered to at Optum's care delivery organizations. The Clinical Quality Analyst will be part of the national Clinical Performance team and will be accountable for achieving results primarily in the Western region of the United States. If you are located in California or Washington, you will have the flexibility to telecommute* as you take on some tough challenges . Primary Responsibilities: Conduct desktop, virtual and on-site surveys to validate adherence to safety standards at Optum's newly acquired and existing care delivery organizations Provide implementation support for safety standards through consultation, training and education at newly acquired and existing care deliver organizations In collaboration with care delivery organizations, develop and drive implementation of remediation plans to resolve non-adherence Validate remediation is complete and sustained...

Come grow with us at AccessNurse! Are you looking for an exciting alternative to traditional nursing? Are you tired of 12 hour shifts and the physical wear and tear of working in the hospital? AccessNurse has an opportunity for you! The AccessNurse-TeamHealth Medical Call Center is a 24/7 Call Center offering telephone triage and Health Information services to Hospitals, Physician Offices, and Insurance Plans across the country. If you want to be a part of a growing industry and work from home, contact us today! We are searching for registered nurses of all backgrounds and levels of experience who are seeking an exciting and rewarding alternative to traditional nursing. If you are looking for a way to continue to care for patients without the wear and tear of working in a hospital you should send your resume today! We offer a wonderful work environment, excellent benefits, competitive pay and paid time off. Weekend and evening shifts are currently available. Now also...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) In this Health and Social Services Coordinator role, will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs. If you are located in Boston, MA , you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service...