Utilization Management RN - Take a break from direct care!

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.



UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 16 million people who receive our unique blend of packages and programs. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards.

 

Enjoy regular business hours, a wide range of professional exposure and an nice change from direct care when you join us in this key role. We’re looking for an experienced RN to assist with conducting research and investigating denied claims, while working closely with our medical directors and external consultants. Responsibilities include:



 


Analyzing medical records, progress notes, nurses' notes, and physician notes submitted with denied claims
Determining whether or not original denials were justified
Writing a summary of your findings and reviewing with the medical director
Advocating decisions for upholding or overturning decision
Generating decision letters for forwarding them to the appropriate parties
Discussing denied claims with outside consultants as needed
Documenting appeals activities in the computer system



Only candidates with current, unrestricted RN licenses for the state of Maryland and recent clinical experience will be considered. A background in UR/UM is preferred, as is experience providing customer service. Experience in the insurance industry would be helpful. Candidates must be computer savvy and able to work effectively in a changing environment. Bachelor’s or Master’s degree preferred.

 

UnitedHealth Group offers a full range of comprehensive benefits, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.

 

If you are interested in growing professionally within an innovative, highly respected organization, we invite you to explore this excellent growth opportunity!

 

Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.