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Clinical Appeals Nurse, Home Infusion - Office Based - Lenexa, KS

UnitedHealth Group


Location:
Lenexa, KS
Date:
04/28/2017
Job Code:
1714567
Apply on the Company Site
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Job Details


Clinical Appeals Nurse, Home Infusion - Office Based - Lenexa, KS(Job Number:699478)
Description

 

Careers with OptumRx. We’re one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You’ll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There’s no better place to help people live healthier lives while doing your life's best work.(sm)

 

Under supervision, investigates and submits complex and sensitive infusion service - related documentation to health insurance carriers on behalf of OptumRx / AxelaCare patients. Analyzes past, current and proposed treatment protocols to ensure their appropriateness and responsiveness to patient needs. Conducts clinical literature research and reviews payor coverage guidelines.  Writes clinical summaries or appeals for patients requiring complex infusible medications. Develops written patient history and infusion treatment proposals to meet specific patient health insurance needs.  May engage in dialog with Medical Directors or other clinicians at the payors to discuss patient charts or other clinical data.

 

Primary Responsibilities:

  • Receive patient history from patients, family members and physicians’ office
  • Provide assistance to the patient with obtaining facts and care history to substantiate appropriate infusion treatment
  • Document patient demographic data, synopsis of care history, and compose letters or e - mails to payers with proposed treatment plan in accordance with health plan requirements
  • Develop a consultant relationship with assigned physicians / clinics / patients to build and sustain a patient - focused approached to care
  • Examine work for exactness, neatness, and conformance to templates and company processes
  • Influence change across assigned payers
  • Facilitate resolution of treatment requests for assigned patients
  • Advocates patient viewpoints to payers on decisions directly affecting coverage - related concerns
  • Provide opportunities for patient involvement and input on care related issues and concerns to demonstrate commitment and responsiveness to patient needs
  • Participate on committees, work groups, and / or process improvement teams that improve patient outcomes and satisfaction
  • Reports statistical results of all efforts by presentations as needed at meetings of the management team

 


Job Clinical Appeals
Primary Location US-KS-Lenexa
Other Location 
Organization OptumRx AxelaCare
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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