Utilization Management / Pre Authorization RN - Pittsburgh
Location: Pittsburgh Pennsylvania
Description: UnitedHealth Group is at the momment seeking for Utilization Management / Pre Authorization RN - Pittsburgh right now, this occupation will be placed in Pennsylvania. For detail informations about this occupation opportunity please read the description below. Utilization Management Nurse/ Pre Authorization Nurse
· Determines medical appropria! teness of elective admissions and outpatient services following evaluation of medical guidelines and benefit determination
· Performs medical necessity reviews using medical policies, Milliman, Interqual and Medicare criteria
· Gathers clinical information needed for medical necessity reviews
· Maintains appropriate documentation following Prior Auth Standard Operating Procedures
· Consults with the Medical Director as needed to troubleshoot difficult or complex cases
· Participates in telephonic and in-person staff meetings
UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:
· UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affor! dable benefits services.
· UnitedHealthcare Medicare & ! Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.
· UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.
Together, we’re removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.Come grow and thrive in our culture of innovation and ideas, because there is no opportunity greater! than the quest to help people live healthier lives.
UnitedHealthcare is currently seeking a Prior Authorization Nurse who will be responsible for, but not limited to the following duties:
Qualifications
· Current, unrestricted RN license in state of residence
· Minimum of 3 years experience (including clinical experience) in an inpatient/acute setting
· Minimum of 3 years experience with MS Office Products (Including Word, Excel, PowerPoint, and Outlook)
Preferred Qualifications
· A Bachelors degree
· Background in discharge planning and/or chart review
· Prior experience in utilization review
· Familiarity with Milliman, Medicare and Interqual criteria guidelines would be helpful
· Ability to build and maintain relationships
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a dr! ug test before beginning employment. In addition, employees in certain ! positions are subject to random drug testing.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to UnitedHealth Group.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Sat, 06 Apr 2013 07:06:27 GMT
Apply Utilization Management / Pre Authorization RN - Pittsburgh Here
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