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Onsite RN Case Manager - OptumRX - Workers Compensation - Philadelphia, PA

UnitedHealth Group


Location:
Philadelphia, PA
Date:
09/05/2017
2017-09-052017-10-04
Job Code:
1776323
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Job Details


Onsite RN Case Manager - OptumRX - Workers Compensation - Philadelphia, PA(Job Number:726542)
Description

Responsible for providing medical case management for the Workers Compensation Department. Reviews treatments plans based on causality and medical necessity.
 
Primary Responsibilities:
  • Ensures accuracy, quality and timeliness of reviews are in accordance with PA regulations and departmental policy and procedures and account protocols
  • Ensures all notices are accurate and processed timely in accordance with PA regulations and departmental policy and procedures and account protocols
  • Reviews and evaluates all medical correspondence received
  • 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 PA 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 PA 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-Philadelphia
Other Location 
Organization OptumRx Workers Comp
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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