Utilization Management Nurse - RN or LPN - Brand new team

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.Ovations Enterprise Services provides a variety of services, including Claims Processing and Customer Care, to all Ovations organizations.Ovations is a family of UnitedHealth Group businesses dedicated to improving the health and well-being of Americans ages 50 and older.New Mexico announces a new statewide, coordinated long-term care program in which Evercare will be one of two health plans serving close to 40,000 Medicaid recipients. Evercare is a premier clinical care management organization, and collaborates with federal and state leaders to create new programs to serve this population. This program is the culmination of years of planning with the State of New Mexico, and we look forward to building partnerships here with our new members, providers and community organizations. We’re looking for an RN or LPN with a managed care background to join our new team in Albuquerque. As the Utilization Management Nurse, you would authorize hospital admissions and requests for inpatient or outpatient services. This is an excellent opportunity to get in on the ground floor of an exciting new program within a strong, stable company where your career could grow. Enjoy a great M-F schedule with no night shifts; apply today. Key responsibilities of the Utilization Management Nurse include: Giving authorizations on requested services Determining if the requests meet criteria dictated by member benefits, state and federal guidelines and medical necessity Preparing the information for the medical director’s review if requests do not meet criteria Preparing member denial letters Conducting telephonic concurrent review on hospitalized members Working with Case Managers to prepare discharge plans and authorize next level of service Assisting with the preparation of monthly productivity statisticsRequirements include: Current, unrestricted RN or LPN licensure (RN preferred) A background in managed care Familiarity with Medicare or Medicaid rules and regulations Computer proficiency and experience using computerized documentation Excellent verbal and written communication skills In addition, ideal assets include: Concurrent review experience Microsoft Excel skills UnitedHealth Group offers a full range of comprehensive benefits to full-time and part-time employees, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.  Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.Keywords: RN, LPN, registered nurse, licensed practical nurse, medicare, Medicaid, managed care, concurrent review, utilization review, case manager, case management, discharge planning, nurse, nursing