UnitedHealthcare Nursing Jobs and Careers

Clinical Appeals RN - Remote - M-F working alternating Saturdays

apartment UnitedHealthcare location_onCypress, CA

$28.27 - $50.48 / HOUR

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. The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification). You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities Review medical records and verify if the requested service meets criteria Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits Review and interpret Plan language Coordinate reviews with the Medical Director Utilize clinical guidelines and criteria Accurately documenting determinations Adherence to all confidentiality regulations and agreements Hours M-F 8a-5p with alternating Saturdays Comfortable working mandatory overtime 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 Active, unrestricted RN license in state of residence 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting Proficiency in Microsoft Office, Word, Outlook, and Internet applications Available M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday) Preferred Qualifications Bachelor of Science in Nursing 1+ years of experience using MCG and/or Medicare criteria 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience Appeals experience Proven excellent communication, interpersonal, problem-solving, and analytical skills All employees working remotely 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 re 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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. 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.

CNA

Full-time

Field Care Coordinator - Richmond, VA

apartment UnitedHealthcare location_onRichmond, VA

$23.89 - $42.69 / HOUR

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. This is a field-based position with a home-based office based in Richmond, VA Market. For consideration, you must reside within a commutable distance of Richmond, VA. The Field Care Coordinator is responsible for facilitating, promoting, and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients. Additionally, the care coordinator is responsible for assessing the availability of natural supports such as the enrollee's representative or family members to ensure the ongoing mental and physical health of those natural supports. The Field Care Coordinator collaborates with the Interdisciplinary Team to coordinate the delivery of comprehensive, efficient, cost-effective patient care. The Field Care Coordinator will be traveling into enrollees' homes, nursing facilities, Adult Day Health, and Adult Living Facilities (ALF) to conduct in-depth assessments and develop the plan of care. The Field Care Coordinator actively assists enrollees with care transitions in collaboration with the Interdisciplinary Team and the acute or skilled facility staff, and the enrollees and / or the enrollees' representatives. Field Care Coordinators act as liaison between the Health Plan, the Commonwealth, enrollees, and their families. Field Care Coordinators follow established professional standards of care, Commonwealth guidelines and policy and procedures. If you are located in commutable distance of Richmond, VA, you will have the flexibility to work remotely* as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Advocate for members and families as needed to ensure the member'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 and unrestricted Licensed Practical Nurse in the state of Virginia OR Social Work or Human Services (or related field) with a 4-year degree 3+ years of care coordination or behavioral health experience and/or work in a healthcare environment 1+ years of experience with MS Office, including Word, Excel, and Outlook Experience working with members who have medical needs, the elderly, individuals with physical disabilities and / or those who may have communication barriers Driver's license and reliable transportation and the ability to travel within assigned territory to meet with members and providers Preferred Qualifications CCM certification Experience working with Medicaid / Medicare population Experience working in team-based care Long term care / geriatric experience Background in Managed Care Physical Requirements Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members and/or providers Ability to transport equipment to and from field locations needed for visits (ex. laptop, stethoscope, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties All employees working remotely 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 $23.89 to $42.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ 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.

RN

Full-time

Senior Clinical Admin RN - Emerging CARE - Remote

apartment UnitedHealthcare location_onNashville, TN

$58,800 - $105,000 / YEAR

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Be part of an exciting opportunity combining your entrepreneurial drive and passion to help others. This is a new program to build trusted relationships with members across the continuum of care as a registered nurse providing guidance and education as appropriate. The goal of this program is to provide a front line clinical resource to provide education and support of members about management of their health and well-being. This role is very customer service oriented and benefits from a nursing generalist background. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities Acts as resource to members calling into a customer service setting addressing medical/health questions Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member Provide process and status on previously submitted prior authorizations or pre-determination requests Effectively refers and enrolls members to appropriate internal specialists and programs, based on member's needs and eligibility Support and advocate for members and families in complicated medical situations Use good nursing judgement in a variety of scenarios real time Accurately documents member interaction across multiple databases, while on the call and appropriate follow all processes and procedures Educates members in healthcare decision making Takes lead role in setting direction and participating in or developing new program and initiatives to improve performance of new program Ability to collaborate with peers and managers to improve service model performance Assists with the development and implementation of departmental policies and procedures Enjoys working in a fast paced environment and must be able to adapt quickly to change while executing efficiently Candidate must be willing to work Monday - Friday 8:00 am - 5:00 pm 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 and unrestricted RN compact license 4+ years of acute nursing experience as an RN Med-surg, critical care and/or ER experience Basic computer proficiency (ie MS Word, Outlook) Proven ability to function independently and responsibly with minimal supervision Preferred Qualifications Bachelor's degree in nursing CCM 2+ years managed care experience 2+ years of case management experience Behavioral health/substance use disorder experience Pediatric experience Utilization management experience Adverse Determination experience Telecommute experience Soft Skills Demonstrated excellent verbal and written communication skills Excellent customer service orientation Proven team player and team building skills Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment All employees working remotely 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 salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. 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. 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.

CNA

Full-time

Field Care Coordinator - Richmond, VA Market

apartment UnitedHealthcare location_onCape Charles, VA

$23.89 - $42.69 / HOUR

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. This is a field-based position with a home-based office in the Central VA Market. The Field Care Coordinator is responsible for facilitating, promoting, and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients. Additionally, the care coordinator is responsible for assessing the availability of natural supports such as the enrollee's representative or family members to ensure the ongoing mental and physical health of those natural supports. The Field Care Coordinator collaborates with the Interdisciplinary Team to coordinate the delivery of comprehensive, efficient, cost-effective patient care. The Field Care Coordinator will be traveling into enrollees' homes, nursing facilities, Adult Day Health, and Adult Living Facilities (ALF) to conduct in-depth assessments and develop the plan of care. The Field Care Coordinator actively assists enrollees with care transitions in collaboration with the Interdisciplinary Team and the acute or skilled facility staff, and the enrollees and / or the enrollees' representatives. Field Care Coordinators act as liaison between the Health Plan, the Commonwealth, enrollees, and their families. Field Care Coordinators follow established professional standards of care, Commonwealth guidelines and policy and procedures. If you are located in commutable distance of Richmond, VA Market, you will have the flexibility to work remotely* as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Advocate for members and families as needed to ensure the member'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 and unrestricted Licensed Practical Nurse in the state of Virginia OR Social Work or Human Services (or related field) with a 4-year degree 3+ years of care coordination or behavioral health experience and/or work in a healthcare environment 1+ years of experience with MS Office, including Word, Excel, and Outlook Experience working with members who have medical needs, the elderly, individuals with physical disabilities and / or those who may have communication barriers Driver's license and reliable transportation and the ability to travel within assigned territory to meet with members and providers Preferred Qualifications CCM certification Experience working with Medicaid / Medicare population Experience working in team-based care Long term care / geriatric experience Background in Managed Care Physical Requirements Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members and/or providers Ability to transport equipment to and from field locations needed for visits (ex. laptop, stethoscope, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties All employees working remotely 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 $23.89 to $42.69 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.

CNA

Full-time

Field Care Coordinator - Richmond, VA Market - Remote

apartment UnitedHealthcare location_onCape Charles, VA

$23.89 - $42.69 / HOUR

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. This is a field-based position with a home-based office in the Central VA Market. The Field Care Coordinator is responsible for facilitating, promoting, and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients. Additionally, the care coordinator is responsible for assessing the availability of natural supports such as the enrollee's representative or family members to ensure the ongoing mental and physical health of those natural supports. The Field Care Coordinator collaborates with the Interdisciplinary Team to coordinate the delivery of comprehensive, efficient, cost-effective patient care. The Field Care Coordinator will be traveling into enrollees' homes, nursing facilities, Adult Day Health, and Adult Living Facilities (ALF) to conduct in-depth assessments and develop the plan of care. The Field Care Coordinator actively assists enrollees with care transitions in collaboration with the Interdisciplinary Team and the acute or skilled facility staff, and the enrollees and / or the enrollees' representatives. Field Care Coordinators act as liaison between the Health Plan, the Commonwealth, enrollees, and their families. Field Care Coordinators follow established professional standards of care, Commonwealth guidelines and policy and procedures. If you are located in commutable distance of Richmond, VA Market, you will have the flexibility to work remotely* as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Advocate for members and families as needed to ensure the member'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 and unrestricted Licensed Practical Nurse in the state of Virginia OR Social Work or Human Services (or related field) with a 4-year degree 3+ years of care coordination or behavioral health experience and/or work in a healthcare environment 1+ years of experience with MS Office, including Word, Excel, and Outlook Experience working with members who have medical needs, the elderly, individuals with physical disabilities and / or those who may have communication barriers Driver's license and reliable transportation and the ability to travel within assigned territory to meet with members and providers Preferred Qualifications CCM certification Experience working with Medicaid / Medicare population Experience working in team-based care Long term care / geriatric experience Background in Managed Care Physical Requirements Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members and/or providers Ability to transport equipment to and from field locations needed for visits (ex. laptop, stethoscope, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties All employees working remotely 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 $23.89 to $42.69 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.