UnitedHealth Group-posted 7 months ago
$59,500 - $116,600/Yr
Full-time • Entry Level
Remote • Plantation, FL
Insurance Carriers and Related Activities

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. If you reside in the state of FL, you will have the flexibility to work remotely as you take on some tough challenges.

  • Perform utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management)
  • Determine medical necessity for in home LTC services and support
  • Identify solutions to non-standard requests and problems
  • Work with minimal guidance; seeks guidance on only the most complex tasks
  • Translate concepts into practice
  • Provide explanations and information to others on difficult issues
  • Coach, provide feedback and guide others
  • Act as a resource for others with less experience
  • Critical analysis of case manager UM submission with review of supporting tools
  • Communication and collaboration with Medical Director
  • Case preparation and presentation for Medical Director review
  • Documentation in supportive rationale for UM decision
  • Timely and accurate documentation in database of UM decision
  • Unrestricted RN license required in state of residence
  • 1+ years of managed Care and / or Clinical experience preferably working within Medicaid and Utilization Management
  • 1+ years of Medicaid Utilization Management experience
  • 1+ years of experience creating, editing, saving and sending documents utilizing Microsoft Office (Word, Excel, PowerPoint)
  • 1+ years of experiencing navigating in a Windows environment
  • Undergraduate degree
  • State Medicaid Managed Care experience
  • Pre-authorization experience
  • Utilization Management experience
  • Case Management experience
  • Experienced in Medicare utilization management
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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