RN Clinical Coordinator - C&S Colorado UM Special Projects - US Remote

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

In this RN Clinical Coordinator - C&S Colorado UM Special Projects role, you will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs.

If you are willing to work 8 am to 5 pm Mountain Standard Time and is located anywhere within the U.S, you will have the flexibility to work remotely* as you take on some tough challenges

Primary Responsibilities:

• Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
• Apply evidence-based criteria to review prior authorization requests and concurrent review for inpatient hospitalizations
• Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services
• Manage the care plan throughout the continuum of care as a single point of contact
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Current, unrestricted independent licensure as a Registered Nurse in Colorado or a compact nursing state license
• 3+ years of clinical experience
• 1+ years of experience with MS Office, including Word, Excel, and Outlook
• Willing or ability to work 8:00am to 5:00pm Mountain Standard Time.

Preferred Qualifications:

• BSN, Master's degree, or higher in clinical field
• CPC licensure
• CCM certification
• 1+ years of utilization management experience
• Experience with electronic medical records
• General prior authorization coding knowledge
• ICD-10, CPT and HCPCS coding knowledge
  
• Knowledge of evidence-based criteria
• Knowledge of regulatory standards such as CMS, Colorado State Medicaid, Colorado Division of Insurance and NCQA standards
• Background in Managed Care
• Ability to work independently

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.