Global insurance Clinical Care Manager - Bilingual Japanese RN - Remote

UnitedHealth Group • Tampa, FL

5d • Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together
The Global insurance Clinical Care Manager – Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States.
This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation.
You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

• Registered Nurse with an active unrestricted United States license
• Must be bilingual in Japanese and English, with strong verbal and written communication skills
• 3+ years of experience in medical-surgical inpatient acute care
• Experience with working in collaboration with Medical Director to review care plans make recommendations. Ability to advocate on behalf of the member’s needs while considering contractual limitations
• Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals
• Proven communication skills at all levels
• Proven ability to be flexible and display a positive attitude
• Proven solid problem-solving, organizational and crisis management skills
• Proven ability to function confidently and efficiently in fast paced work environment
• Proven ability to foster team cohesion in an international virtual environment
• Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations
• Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members
• Proven advanced software skills with ability to work in multiple platforms with clinical case reviews
• Proven advanced skills with Microsoft Office - Excel, Word
• Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs

Nice To Haves

• Bachelor’s degree
• 2+ years of experience in utilization management or case management in a managed care or hospital environment
• Experience in international healthcare and/or air medical transport
• Experience in discharge planning and/or chart review
• International travel experience
• Demonstrated familiarity with InterQual criteria guidelines
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

• A GI CCM must consider both US and international care standards and regulatory guidelines.
• They must be able to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to perform the clinical review
• Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches
• The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims

Benefits

• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees