Sign In
 [New User? Sign Up]
Mobile Version

Clinical Consultant - Omaha, Nebraska

UnitedHealth Group

Omaha, NE
Job Code:
Apply on the Company Site
  • Save Ad
  • Email Friend
  • Print
  • Research Salary

Job Details

751525 Clinical Consultant Nebraska

Clinical Consultant - Omaha, Nebraska (751525)

Position Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)


This will be an office based position in Omaha, NE.


Primary Responsibilities:

  • Prepares Health Services state reports, quarterly and ad hoc
  • Runs reports with data analysis
  • Maintains ER Data base for State Mandatory ER PIP
  • Maintains the various spreadsheets for all Health Services meetings
  • Nurse Line database and reporting 
  • Works in collaboration with HSD on yearly UM and CM Program evaluations
  • Research and prep on cases going to Media - Involved in High Profile Katie Beckett and PDN Members cases
  • Member contact via phone and in person for HRCM
  • Involved in transplant and HRCM activities
  • Participates in EQRO and NCQA Audits (NCQA measures QI 7,8,9,10)
  • Completes monthly chart audits on HRCM cases
  • Leads or is instrumental in the following meetings: HQUM, Magellan member conferences, ER PIP work group, Asthma initiative, Meetings with HSD and MD on high profile cases; UNMC, Uninet ER collaboration HRCM meetings, Top 5% member management, weekly MDR, Member Interdisciplinary conferences for KB and PDN members, participates in P&P meetings, involved in monthly mandatory state restrictive services conference calls
  • Monthly Health Plan COC meeting
  • Participates in the following work groups: Appeals and Grievances, Provider Satisfaction, Provider admin guide revamp, Lead Members, Sickle Cell Disease, CHF
  • Marketing efforts: Baby Blocks, Baby Showers
  • Appeal Letter maintenance
  • Compliance Meetings 
  • Maintains and builds relationships with all aspects of UHC such as: Interaction with Optum Services, BI, Appeals and Grievances, Compliance, Providers, Hospitals, Vendors and Members
  • Policy and Procedures: Maintains all P&Ps for the Health Services area
  • State Expansions: Proof Points for Nebraska RFP
  • Additional duties as needed by Director of Health Services

Required Qualifications:  

  • Active, unrestricted RN license in the state of NE
  • Intermediate to Advanced computer proficiency in Microsoft Word, Excel, Outlook, PowerPoint and Internet
  • Experience with presenting presentations and public speaking  

Preferred Qualifications:  

  • 5+ years RN experience in performing UM, CM responsibilities working with the Medicaid population   
  • Knowledge of Nebraska Administrative Code (NAC Manual)
  • UR background
  • Demonstrated leadership capabilities
  • Experience with quality improvement initiatives
  • Program development experience
  • Data Analysis  experience
  • Experience interfacing with Regulatory and State Govt. Officials

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: RN, Registered Nurse, Nurse Consultant, Medicaid, Case Management, Utilization Management, Utilization Review, UM, UR, case management, quality improvement, data analysis, Omaha, Lincoln, Grand Island, Kearney, North Platte, NE, Nebraska

Job Details

  • Contest Number751525
  • Job TitleClinical Consultant - Omaha, Nebraska
  • Job FamilyNursing
  • Business SegmentCommunity and State

Job Location Information

  • Omaha, NE
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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.

Powered ByLogo

Featured Jobs[ View All ]

Featured Employers [ View All ]