Job Description: 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 with OrthoNet, a non-integrated entity to UnitedHealth Group, 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 OrthoCare Manager is directly responsible to either the Manager or Director of, Medical Management depending upon their job location and program that they are managing, and has the administrative responsibility for the overall direction, utilization, supervision, instruction, and examination of the medical care of the member assigned to them. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Job Responsibilities: Maintains contact with all parties involved in case necessary for case management for the client Preparation and filing of reports, outcome data, and records needed by OrthoNet Ensure clinical information submitted for peer review and entered into patient’s electronic record is the most accurate and up to date Collaborate with Contract Assistants working on their team to ensure that responses to authorization requests are responded to within Regulatory time frames Maintains contact and communicates with insurance companies to apprise them of case activity, case direction or receive authorization services Review of Musculoskeletal (MSK) care evaluations and progress reports to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria for either initial or continued authorization Review documentation submitted to support the medical necessity of the request Interacting with the physician to ensure the most appropriate and highest quality of care is recommended Acts as clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to maximize quality of patient care as well as effectively manage length of stay and utilization resources as appropriate Job Requirements: Willing and able to obtain additional State RN Licensure(s), if necessary Managed Care Milliman (MCG), CMS and / or InterQual experience Telephonic case management experience Pain Management experience Certified Case Manager (CCM) BSN Compact RN license Utilization review and/or prior authorization experience Qualification & Experience: Must have a designated work space and access to install secure high speed Internet via cable / DSL in home Demonstrate a proficiency in computer skills including Microsoft Word, with the ability to navigate a Windows environment 1+ years of Musculoskeletal and / or Orthopedic experience in a Case Management or Prior Authorization role Current, unrestricted RN license in your State of Residence. (May be willing to consider equivalent work experience in lieu of RN License.) Attention to detail, organizational skills and multitasking abilities will be keys to success 5+ years of hands on clinical experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company Strong written and verbal communication skills Job Details: Company: UnitedHealthcare Vacancy Type: Full Time Job Location: Newark, NJ, US Application Deadline: N/A Apply Here careersvite.com
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