Transplant Prior Authorization RN Case Manager - Telecommute

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 and help people live healthier lives while doing your life's best work.(sm)

As a Transplant Prior Authorization RN Case Manager, you will drive positive outcomes by supporting a diverse member population with education, advocacy and the connections to the resources they need.

This role is required to work Monday - Friday from 8:00am to 5:0pm (with some flexibility). The schedule requires some days to be worked until 6:00pm as needed.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Makes outbound calls to assess members' current health status

Case manages members in the pre-operative and post-operative phases

Utilizes Milliman criteria to determine clinical coverage

Identifies gaps or barriers in treatment plans

Provides patient education to assist with self-management

Interacts with Medical Directors on challenging cases

Coordinates care for members

Makes referrals to outside sources

Coordinates services as needed (home health, DME, etc.)

Educates members on disease processes

Encourages members to make healthy lifestyle changes

Documents and tracks findings

Makes welcome home calls to ensure that discharged member receive the necessary services and resources

Required Qualifications:

Current, unrestricted RN license in your state of residence

Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses

3+ years of experience as a Registered Nurse (RN) with a broad-range of nursing skills/focus (i.e. ICU, Step-down, Cardiology, etc.)

1+ year of Transplant or Oncology experience working as an RN

Basic level of proficiency with Microsoft Word, with the ability to navigate a Windows environment

Access to high-speed internet from home (Broadband cable, DSL or fiber)

Dedicated workspace from home

Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

Bachelor's Degree

Reside in compact state with compact license

Certified Case Manager (CCM)

Transplant experience working in an environment where transplant was the main focus of your job

Managed care experience

Case Management experience

Experience working with bone marrow transplants

Experience working with solid organ transplants

Discharge planning experience

Experience educating patients

Experience in utilization review, concurrent review and/or risk management

Knowledge of Milliman (MCG) or InterQual criteria

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $53,300 to $95,100. The salary range for Connecticut/Nevada residents is $58,800 to $104,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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

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.