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Case Manager RN - Auto Accident Division - Norristown, PA

UnitedHealth Group


Location:
Norristown, PA
Date:
08/18/2017
2017-08-182017-09-16
Job Code:
1773211
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Job Details


Case Manager RN - Auto Accident Division - Norristown, PA(Job Number:725211)
Description

Responsible for providing telephonic medical case management for the Auto TCM Department. Reviews treatments plans based on causality and medical necessity.
 
Primary Responsibilities:
  • Ensures accuracy, quality and timeliness of reviews are in accordance with NJ regulations and departmental policy and procedures and account protocols
  • Ensures all notices are accurate and processed timely in accordance with NJ regulations and departmental policy and procedures and account protocols
  • Reviews and evaluates all medical correspondence received
  • Identifies that properly submitted treatment plans that quality for authorization are processed in accordance with NJ regulations and departmental policy and procedures and account protocols
  • Identifies that properly submitted treatment plans that quality for  a Medical Director Review (MDR) are processed in accordance with NJ regulations and departmental policy and procedures and account protocols
  • Identifies that properly submitted treatment plans that quality for TCM Negotiation are processed in accordance with NJ regulations and departmental policy and procedures and account protocols
  • Identifies and recommends Independent Medical Examinations (IMEs), Retrospective Peer Reviews, and referrals to Field Based Case Management (FBCM) as necessary and in accordance with NJ regulations and departmental policy and procedures and account protocols
  • Identifies approved services appropriate for referral to Cypress Care according to account specific protocols and properly completes the referral according to departmental policy and procedures and account protocols
  • Reviews the claim treatment history with internal and external contacts in accordance with NJ regulations and departmental policy and procedures and account protocols
  • Evaluates clinical file and ensures treatment is causally related and medically necessary
  • Adheres to cost savings measures and departmental and company-wide Quality Assurance programs
  • Holds to the philosophy and standards of quality as outlined by Procura Management Inc.
  • Adheres to statutory regulations, HIPPA compliance, account protocols and department policy and procedures
  • Generates and processes all AIMS correspondence in accordance with NJ regulations and departmental policy and procedures and proofreads to ensure accuracy
  • Prepares comprehensive summaries following determinations or after significant activity occurs on the file in accordance with departmental policy and procedures and account protocols
  • Maintains the integrity of RMS system at all times and adheres to all electronic paperless workflows
  • Attends in-service meetings and continuing education seminars as appropriate
  • May act as preceptor for TCMs as directed by management
  • Performs other AIMS Department duties as assigned

Job Case Management
Primary Location US-PA-Norristown
Other Location 
Organization OptumRx Workers Comp
Schedule Full-time
Number of Openings 4
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