What you do matters. And who you do it for matters even more. If you're looking for more meaningful impact, you should take a serious look at our growing organization. Since our founding in the mid-90's, Peoples Health has brought innovation and compassion to Medicare patients throughout Louisiana. Now, part of the UnitedHealth Group family of companies, our team consists of over 900 people who are experienced in all aspects of care delivery, health maintenance and administrative support. It's our goal to help guide over 60,000 Medicare recipients across the broad spectrum of health and dental services. We're committed to the highest purpose; improving lives. And that makes us the singular place to do your life's best work.(sm)
The Authorization Nurse is responsible for engaging in the collaborative process which assesses, plans, implements, coordinates, monitors and evaluates services in order to improve member’s health outcomes.
- Review and documentation of requests for services via electronic transmittal and/or fax for inpatient services
- Processes the initial review for all hospitalized members within assigned facilities
- Collaborates with the interdisciplinary care team (ICT) and medical director(s) to facilitate appropriate treatment for members and identify high risk members that will be followed by the care coordinators
- Initiates care coordination (Nurse Practitioner, MSW, RN) referrals for members when necessary
- Monitors the member’s adherence to the plan of care
- Collaborates with the hospital case management staff and facility care providers to review admission and discharge planning
- When appropriate, involves and assists member and/or caregiver in continuation of care to the outpatient setting or alternative levels of care
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.
- Current Louisiana Registered Nurse (RN)
- Experience in a clinic / hospital or similar setting
- Experience with clinical documentation systems
- Experience in assessing members and developing care plans
- Computer / typing proficiency to enter / retrieve data in electronic clinical records and documentation systems; experience with email, internet research, use of online calendars and other software applications
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Bachelor’s in Nursing
- 3+ years of clinical experience in health care and/or managed care
- Experience with medical terminology and coding
- Understanding of healthcare industry
- Working knowledge in Interqual and CMS guidelines
- Understanding of nursing home, skilled nursing facility and long-term acute care regulations
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time 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, Registered Nurse, Managed Care, Research Nurse, Nursing Home, Skilled Nursing Facility, Long Term Acute Care, CMS, PHN Policies, Interqual, Hayes Review, Medical Necessity Review, Medical Review, Metairie, LA, Louisiana, Peopleshealth