UnitedHealthcare Nursing Jobs and Careers

Secondary Review Nurse - Indiana

$28.94 - $51.83 / hour

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. The Secondary Review Nurse plays a critical role in evaluating clinical requests for Home and Community-Based Services (HCBS). This position ensures that care provided is medically necessary, cost-effective, and tailored to the individual needs of each member, while remaining compliant with state regulations. If you reside within the state of Indiana , you will enjoy the flexibility to work remotely * as you take on some tough challenges. Primary Responsibilities Participate in secondary reviews for HCBS services and Medicaid services Review and process prior authorization requests for LTSS and HCBS services Apply clinical judgment and decision support tools to determine medical necessity and appropriateness of services Collaborate with care managers, physicians, and other stakeholders to ensure continuity of care and alignment with the members' service plan Monitor utilization patterns and identify opportunities for improved care coordination and cost containment Document all clinical decisions and communications in accordance with regulatory and organizational standards Support quality improvement initiatives and participate in developing education and training for staff Identify potential quality of care concerns, including instances of over/or underutilization of services and escalate these issues as needed Stay current with established guidelines and regulatory requirements You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications Current, unrestricted RN license for Indiana 3+ years of clinical experience in a hospital, acute care, home health / hospice, direct care or case management and the ability to quickly identify needs and issues 2+ years of experience with completing functional assessments for LTSS services 2+ years of Medicaid, Medicare, or Managed Care experience and with Long-Term Services and Supports Intermediate level of knowledge of LTSS experience determining eligibility and appropriate allocation of services Intermediate level of computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications Preferred Qualifications Pre-authorization experience Utilization Management experience Case Management experience Knowledge of state and federal guidelines Home health or hospice Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $28.94 to $51.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN

Clinical Nurse Manager - Philadelphia, PA

UnitedHealthcare Philadelphia, PA

$91,700 - $163,700 / year

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. This manager will manage RN case managers, CHWs, and BHAs, in accordance with established Compass (formerly Care Model) and ICP Programs, as well as all UHC requirements. Manage productivity and expected outcomes across the teams, engage staff. Must be a critical thinker and have experience in complex care management, chronic conditions, and behavioral health management to manage, lead and advise the teams as a subject matter expect. This role also requires submission of state reports, presentations and public speaking. Data trending, extracting, capturing and analysis are also an essential element of this role. This position is required to be Located in Philadelphia, PA and will require travel 25% If you are located in PA, you will have the flexibility to work remotely* as you take on some tough challenges 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. Required Qualifications Active unrestricted Pennsylvania RN license Case Management Certification 5+ years managing people 3+ years of experience with Medicaid Fluent Microsoft word and Excel Proven excellent writing, and public speaking skills Driver's License and access to a reliable transportation Preferred Qualifications Undergraduate degree RN or SW or Clinical Degree 5+ years of Clinical Experience All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

CNA

Full-time

2 days ago

Field Care Coordinator - Roanoke, VA

UnitedHealthcare Roanoke, VA

$23.89 - $42.69 / hour

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 Field Care Coordinator is responsible for facilitating, promoting, and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients. Additionally, the care coordinator is responsible for assessing the availability of natural supports such as the enrollee's representative or family members to ensure the ongoing mental and physical health of those natural supports. The Field Care Coordinator collaborates with the Interdisciplinary Team to coordinate the delivery of comprehensive, efficient, cost-effective patient care. The Field Care Coordinator will be traveling into enrollees' homes, nursing facilities, Adult Day Health, and Adult Living Facilities (ALF) to conduct in-depth assessments and develop the plan of care. The Field Care Coordinator actively assists enrollees with care transitions in collaboration with the Interdisciplinary Team and the acute or skilled facility staff, and the enrollees and / or the enrollees' representatives. Field Care Coordinators act as liaison between the Health Plan, the Commonwealth, enrollees, and their families. Field Care Coordinators follow established professional standards of care, Commonwealth guidelines and policy and procedures. This is a field-based position based in Roanoke VA Market with a home-based office. For consideration, you must reside within a commutable distance of Roanoke VA as you will be required to travel within the Roanoke VA market. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office for a minimum of four days per week. If you are located in Roanoke, VA, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team 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. Required Qualifications Current and unrestricted Licensed Practical Nurse in the state of Virginia OR Social Work or Human Services (or related field) with a 4-year degree 3+ years of care coordination or behavioral health experience and/or work in a healthcare environment 1+ years of experience with MS Office, including Word, Excel, and Outlook Experience working with members who have medical needs, the elderly, individuals with physical disabilities and / or those who may have communication barriers Driver's license and reliable transportation and the ability to travel within assigned territory to meet with members and providers Preferred Qualifications CCM certification Experience working with Medicaid / Medicare population Experience working in team-based care Long term care / geriatric experience Background in Managed Care Physical Requirements Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members and/or providers Ability to transport equipment to and from field locations needed for visits (ex. laptop, stethoscope, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $23.89 to $42.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Primary Care Nurse Practitioner- Hammond, LA

UnitedHealthcare Hammond, LA

$109,500 - $164,000 / year

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. Primary Care Plus (PCPlus), a value-based care delivery organization, is seeking a certified Nurse Practitioner to join our growing team. Our mission is to provide a path of well-being for our patients through high-quality, cost-effective, and coordinated care that delivers superior outcomes and satisfaction. Primary Responsibilities Provide primary care, including ordering and evaluating diagnostic/screening/laboratory tests, and management of minor acute illnesses Conduct comprehensive wellness assessments on members either in the clinic or patients' home as needed Assess, diagnose and manage chronic conditions for patient population Identify deviations from normal, initiates and evaluates treatment for patients with commonly occurring health problems within their scope of practice Prescribe medications as delegated in the protocols and/or procedures within licensed prescriptive authority Provide individualized patient teaching and counseling Participate in quality improvement activities and monitoring of health outcomes for patients Ensure coding and documentation of HEDIS, Quality STAR measures and Risk Adjustment diagnoses as appropriate Participate in community events including health fairs, speaking engagements, and educational lectures Collaborate with our marketing team to build the practice and help to grow our business and reach within our communities 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. Required Qualifications Successful completion of an advanced practice Nurse Education Program Nurse Practitioner Certification as Adult, Geriatric, or Family NP Current Licensure through the Louisiana Board of Nurse Examiners or the ability to obtain licensure prior to employment CPR certification Valid DEA license or the ability to obtain prior to employment 2+ years of post-graduate experience working as a Nurse Practitioner Demonstrated clinical knowledge necessary to make recommendations concerning the clinical assessment, evaluation and management of membe Computer literate and experience with electronic medical records Preferred Qualifications Experience in Gerontology, Internal Medicine, and/or Family Medicine Experience in a managed care and/or ambulatory environment Urgent care experience Compensation & Benefits Competitive guaranteed salary with annual bonus 36 days off annually (PTO, CME, and holidays) Comprehensive benefits: medical, dental, vision, STD/LTD, CME allowance Malpractice insurance with tail coverage Retirement plans including employer-funded contributions and Employee Stock Purchase Plan (UHG stock) Clinician learning and development programs Compensation for this specialty generally ranges from $109,500 - $164,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. 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. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Preservice Review Nurse - PST time zone - Remote

UnitedHealthcare Las Vegas, NV

$28.94 - $51.63 / hour

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 Preservice Review RN is responsible for reviewing requests received from providers, using approved protocols and criteria. (Milliman Care Guidelines or Healthcare Operations Protocols). The RN is expected to approve those requests that meet medical necessity, along with benefit level, and the contractual status of the provider / facility as appropriate for self-funded lines of business. This position is also a resource to new staff and may precept as well. Candidates must be available to work Monday - Friday from 8:00 am - 5:00 pm PST. *** You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities Evaluate and assess each request verifying eligibility and specific product Determine benefit level based on site of service Utilize written criteria to approve, pend or send the case to the medical director for review Send cases for pending process when appropriate Maintain at least 98% accuracy of clinical review case notes in Facets Maintain productivity standards and maintain compliance with all regulatory agencies including NCQA, DOL, DOI for each state, Medicaid, CMS and OPM Maintain at least 98% accuracy in summarizing cases for the Medical Director to review using appropriate protocols based members clinical and benefit information Maintain compliance with turnaround times based on the member's product, the type of request and the specific regulatory agency Be knowledgeable of and comply with the Nurse Practice Act for each state that licensure is required to perform SHL business Precepts / act as a resource for new staff 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. Required Qualifications A current, unrestricted RN license for the state of Nevada 2+ years of recent critical care, ER and/or med-surg nursing experience Proficient with Microsoft Word to create, edit, save and send documents Proven ability to navigate a Windows environment, Microsoft Outlook, and conduct Internet searches Preferred Qualifications 2+ years Utilization Management experience in managed care, acute or rehab setting Knowledge of utilization review process and prior authorization process in a managed health care industry Knowledge of ICD9 / CPT coding and Milliman Care Guidelines Soft Skills Detail oriented, excellent organizational skills Ability to work well under pressure with sound decision making ability Excellent written and oral communication skills All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.