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Preservice Review Nurse - Air Ambulance and On Call - Arizona

UnitedHealth Group


Location:
Phoenix, AZ
Date:
09/05/2017
2017-09-052017-10-04
Job Code:
1775231
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Job Details


Preservice Review Nurse - Air Ambulance and On Call - Arizona(Job Number:726037)
Description

Are you ready for your next challenge? Discover it here at UnitedHealthcare and help us reinvent the health system. This can be your opportunity to take on a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. You will discuss cases with treating physicians and other healthcare professionals to ensure our members receive the proper health services. You will be required to maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities in order to help patients through their care plan. This is an exciting opportunity at a truly inspired organization. Join us. This can be the start of your life's best work.(sm)  

What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
 
Primary Responsibilities:
  • Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
  • Function as a member of a self-directed team to meet specific individual and team performance metrics
  • Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations
  • Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
  • Acts as a resource for others with less experience
  • Work independently and collaborating with Medical Directors and non-clinical partners
  • Adapt to a highly changing environment and a heavy case load

 

The hours for this position are M-F 9-6 plus ONCALL duties

 

This team crosses all lines of business, processes, and platforms. The team monitors inpatient admissions, outpatient procedures on the EPAL, facility to facility transfers (foreign hospitals to acute inpt. rehab), and air ambulance (international and domestic) reviews.  The air ambulance team has required on call duties and is available 24/7. On-call rotates to one week a month and at times 2 weeks a month due to calendar and/ or PTO. This is a high profile fast paced team with short regulatory requirements and contact with multiple departments, members, vendors and work closely with medical directors.

 

 

 

 


Job Clin Coverage Rvw/Prior Author
Primary Location US-AZ-Phoenix
Other Location US-AZ-Tucson, US-Arizona
Organization CCR/Prior Authorization/MCR
Schedule Full-time
Number of Openings 1
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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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