Program Nurse Coordinator Transplant And Dialysis - Rn - Remote

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 and start doing your life's best work.(sm)

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.

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

Primary Responsibilities:

• Secure, track and review records via multiple media
• Identify program specific documents within member's records
• Submit coverage checks and claims to Allstate on members behalf
• Use clinical judgement to prepare records for external review
• Use clinical judgement to triage patients for program candidacy
• Make appropriate referrals into various programs in a timely manner
• Act as a liaison between COE facilities and Care Managers or referring parties
• Facilitate patient participation in Case Management with regular medical carrier
• Skilled telecommunications in a high-touch member program
• Encourage and support members participating in the program with sensitivity and compassion
• Educate members regarding program policies and procedures
• Evaluate appointments to determine if they fall under the transplant COE guidelines
• Assist members with travel questions related to medical necessities
• Receive and collects data necessary for program enrollment, review, and reporting
• Compile network exception requests for submission to appeals team
• Providing seamless customer service to include updating member information, vendors portals, and internal documentation
• Participate in staff meetings
• Monitor deferred patients monthly to ensure progression and continued suitability for transplant benefit
• Notify patients, COE facilities and Care Managers when program benefit end date is approaching
• Develop and maintain a positive relationship with external vendors

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:

• Registered nurse with BSN or ADN degree
• Unencumbered RN License within the state you reside
• 1+ years of clinical experience as a Registered Nurse
• Intermediate computer skills/knowledge of Microsoft Word and Excel

Preferred Qualifications:

• Experience with Utilization Management
• Experience or knowledge of Transplant
• Experience or knowledge of Dialysis
• Experience with Prior Authorization
• Experience with Case management

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $22.45 to $43.89. 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 employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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.

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.