At Monarch HealthCare, an OptumCare Company, you will perform within an innovative culture focusing on transformational change in the health care system. You will leverage your skills across a diverse and multi - faceted business. Your contributions will have an impact greater than you have ever imagined! Join us and help people live healthier lives while doing your life's best work.(sm) As a part of our continued growth, we are searching for an Utilization RN Case Manager to join our team. Primary Responsibilities:Performs concurrent and retrospective telephonic clinical reviews at the designated network or out-of-network facilities Documenting medical necessity and appropriate level of care utilizing clinical guidelines (Milliman). Complies with CMS regulations and Health Plan requirements Interacts and effectively communicates with members, their families and or designated member representative to assess discharge needs and formulate a discharge plan, provide Health Plan benefit information Interacts daily with treating physicians regarding the Monarch HealthCare member's plan of care and alternative care solutions Effectively communicates plan of care to facility staff, health plan partners, and ambulatory case management
Required Qualifications:Current and unrestricted California RN 2+ years of experience in acute care clinical setting 1+ years of case management experience Microsoft Office - Word / OutlookPreferred Qualifications:Experience working with Milliman and InterQual Experience in utilization management Certified Case Manager (CCM)What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm) 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. Job Keywords: RN, discharge planning, concurrent reviews, InterQual, Milliman, acute care, case manager, UM, discharge planning, Irvine, CA
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.