Requisition Number: 2245738
Job Category: Nursing
Primary Location: Colorado Springs, CO, US
(Remote considered)
For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Preservice Nurse (LPN/LVN) will collaborate with medical directors, nurses and clinical coordinators and communicate, via telephone or secure video, with the supervising provider. The provider will direct the evaluation and care provided. You will work out of a queue and generate letters based on the specific need. All activities will fall within the employee’s scope of practice as set by the State they are practicing in.
Hours: Monday-Friday 8am-5pm in their time zones they reside
If you are located in either Pacific Standard or Mountain Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Researches member benefits and eligibility
- Completes all assigned cases within required timeframes (TAT)
- Processes and documents all case activities per SOPs and DES
- Prepares and documents clinical case review and assigns to Medical Director for Medical Director (LTAC, AIR and SNF) decision
- Communicates and documents Medical Director determinations to providers and members.
- Maintains communications with providers for continuity of care and completion of ALOC requests
- Prepares case information for assignment to National Letter Team
- Submits requested Contract Exceptions for SNF cases
- Educates providers, members and internal staff on guidelines, member benefits, alternate levels of care available
- Acts as a clinical resource to non-Clinical staff
- Collaborates with other internal stakeholder’s/departments for member’s appropriate level of care: Medical Director, Optum/United Nursing Home members, Appeals and Grievances, National Letter team, and Intake/CDU
- Performs self-audits to assure compliance with SOP DES
- Works within HSR, InterQual and, multiple SharePoint sites
- Participates in compliance meetings, process improvement planning
- Reports individual case concerns to manager, Medical Director as needed
- Triage cases received from IPC
- Assign cases to Facility ICM or other work groups
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:
- High School Diploma/GED (or higher)
- Current, unrestricted LVN/LPN license in the state you reside
- 3+ years of experience in Case Management
- Intermediate level of proficiency with Microsoft Excel including the ability to quickly learn Clinical Applications
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Nevada, or Washington Residents Only: The hourly range for this role is $19.47 to $38.08 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.