Remote Utilization Review Rn Jobs in Rochester Hills, MI

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 autonomous Health and Social Services Coordinator role, you will be an essential element of an Integrated Care Model by relaying pertinent information about member needs and advocating for the best possible care available, and ensuring the members have the right services to meet their individualized needs.

If you are located in the state of Michigan, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Analyze, assess, plan and implement care strategies that are adapted to the patient and directed toward the most appropriate, least restrictive level of care
• Actively identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services
• Act as a champion of member care plans throughout the continuum of care and act as a single point of contact
• Confidently communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Courageously advocate for patients and families to ensure the patient's needs and choices are fully represented and supported by the health care team
• Assess members' current health status by making outbound calls and receiving inbound calls
• Recognize gaps or barriers in treatment plans
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
• 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:

• Registered Nurse license in the state of MI 
• 4 years of clinical experience/community health in a healthcare setting
• 2 years of Case Management experience
• 2 years of Medicaid experience
• 1 years of experience working with MS Word, Excel and Outlook
• Must reside in the state of Michigan

Preferred Qualifications:

• Certified Case Manager (CCM)
• Experience working with the needs of vulnerable populations who have chronic or complex conditions
• Experience with electronic charting
• Experience with arranging community resources
• Medicare experience
• Experience or exposure to discharge planning
• Experience in utilization review, concurrent review or risk management
• Background in managing populations with complex medical or behavioral needs
• Acute care experience

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. 

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 hourly pay for this role will range from $29 - $52 per hour 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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