Sign In
 [New User? Sign Up]
Mobile Version

Utilization Management RN or LCSW - Falls Church, VA

UnitedHealth Group

Falls Church, VA
Job Code:
Apply on the Company Site
  • Save Ad
  • Email Friend
  • Print
  • Research Salary

Job Details

742061 Utilization Management RN or LCSW Falls Church VA

Utilization Management RN or LCSW - Falls Church, VA (742061)

Position Description

At UnitedHealth Group, you’ll improve the health of others while you help us heal the entire health care system. As a Utilization Management Nurse or LCSW, you will make sure our health services are administered efficiently and effectively. You’ll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready make an impact? Join us today.
It feels great to have autonomy, and there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact our members. And at the same time, you'll be challenged by leveraging technologies and resources in a rapidly-changing, production-driven environment.
Primary Responsibilities:
  • Perform utilization and concurrent review of inpatient and outpatient cases using Milliman criteria
  • Conduct clinical chart assessments
  • Adhere to regulatory and accreditation standards and timelines with reviews
  • Discuss cases with treating physicians and other health care professionals to better understand plans of care
  • Identify and evaluate delays in care
  • Initiate a discharge planning and readmission prevention plan
  • Arrange alternative care services and maintain communication with acute long term care, acute rehabilitation or skilled nursing facilities
  • Collaborate with case management to identify to identify those members that could benefit from further clinical management

This position will work in the Falls Church, VA office with the ability to telecommute 1-2 days per week following an orientation period and manager approval.

Required Qualifications:
  • Current, unrestricted RN license OR LCSW in the state of VA or the ability to obtain upon hire
  • 1+ year of clinical and / or behavioral experience, including recent clinical experience in an inpatient / acute setting
  • Experience in utilization management
  • Experience working with Microsoft Windows and the ability to toggle between various systems
Preferred Qualifications:
  • Case management certification and / or experience
  • Experience with behavioral health
  • Experience with utilization management in a health plan
  • Experience in discharge planning and / or chart review
  • Familiarity with Milliman criteria and ASAM criteria
  • Experience working with Trizetto

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)

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:  Registered Nurse, Nurse, RN, Social Worker, LCSW, INTotal2017, Utilization, Prior Authorization, UR, Utilization Management, UM, Case Management, Case Manager, Quality, Quality Improvement, Health Care, Medicaid, Medicare, Managed Care, Milliman, Interqual, Regulatory Compliance, CMS, Clinical, Falls Church, Virginia, VA, UHC, UnitedHealthcare, Community and State, Public Sector

Job Details

  • Contest Number742061
  • Job TitleUtilization Management RN or LCSW - Falls Church, VA
  • Job FamilyNursing
  • Business SegmentCommunity and State

Job Location Information

  • Falls Church, VA
    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 ]