Transplant Utilization Management RN

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

We're making a solid 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 Transplant Case Manager RN with 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!

Shift: Monday - Friday, 8:00am - 5:00pm in your time zone.
This position is approximately 75% Utilization Management and 25% Case Management

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Perform utilization management for transplant services for Medicare Advantage and Dual eligible members
• Perform utilization review of inpatient cases
• Direct providers and members to contracted provider network and facilities
• Coordinate with the transplant facility through all phases of the transplant process, from initial evaluation to 365 days post-transplant, ensuring seamless communication and comprehensive patient care
• Make outbound calls to assess members' current health status
• Identify gaps or barriers in treatment plans
• Provide patient education to assist with self-management
• Make referrals to outside sources
• Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels
• This is high volume, customer service environment. You'll need to be efficient, productive and thorough through telephonic interaction
• Solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes
  
  

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, unrestricted RN license in the state of residence
• Ability to obtain Nurse license in other states as needed
• 3+ years of RN experience in a hospital, acute care or direct care setting
• 1+ years of experience working with solid organ or bone marrow transplants as a Nurse
• Ability to type and navigate a Windows based environment
• Access to high speed internet from home (Broadband Cable, DSL or Fiber)
• Dedicated workspace from home
  
  

Preferred Qualifications:

• BSN
• Compact RN license
• Certified Case Manager (CCM)
• 3+ years of experience as a Transplant Coordinator
• 1+ years of utilization management experience
• Experience in utilization review, concurrent review or risk management
• Case management experience
• Experience or exposure to discharge planning
• Experience in a telephonic role
• Background in managed care
  
  

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.