Optum Utilization Review Jobs in Maine (NOW HIRING)

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. 

Responsibilities:

• Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc.; serves as an educational resource to all Health System staff regarding utilization review
• Assessment of physical, psychosocial, & economic needs for transition of care planning to a variety of levels of care; delegates to others as appropriate
• Documents, verifies, and validates specific data required to monitor and evaluate interventions and outcomes
• Interviews and collects patient specified data and chart review related to readmission and appropriately notifies care team
• Communicates telephonically and electronically with outpatient providers in an effort to enhance the continuum of care
• Integrates performance improvement principles and customer service excellence principles into all aspects of job responsibilities; practice and governmental commercial payer guidelines
• Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies
• Assumes responsibility for NL EMMC required continued education and owns professional growth
• Provides leadership in the coordination of patient-centered care across the continuum, develops a safe discharge plan through collaboration with the patients / caregivers and multidisciplinary healthcare team to arrange appropriate post discharge services and optimal transitions in care
• Drives to appropriate DRG length of stay, patient experience, and reimbursement for all patients
• Promotes patient advocacy in an independent care model
• Performs other duties as assigned or required

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:

• Associates degree
• Current, unrestricted RN license in the state of employment
• 3 years of experience in a hospital, acute care or direct care setting
• Must be able to type and have the ability to navigate a Windows based environment

Preferred Qualifications:

• BSN
• Background in managed care
• Case management experience
• ACM, CCM or other certification applicable to utilization management
• Experience or exposure to discharge planning
• Experience in utilization review, concurrent review or risk management
• Previous experience in a telephonic role
• Answer the call to use your diverse knowledge and experience to make health care work better for our patients. Join us and start doing your life's best work

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.  

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.

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