Pre-service Review Nurse RN – Air Ambulance and On Call – Telecommute (virtual) (738639); Tampa, Florida.

Full-Time
Florida
Are you ready for your next challenge? Discover it here at United Health care and help us reinvent the health system. This can be your opportunity to take on a role that helps us offer a higher level of care than you’ll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. You will discuss cases with treating physicians and other health care professionals to ensure our members receive the proper health services. You will be required to maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities in order to help patients through their care plan. This is an exciting opportunity at a truly inspired organization. Join us. This can be the start of your life’s best work.(sm)
What makes your nursing career greater with United Health Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you’ll open doors for yourself that simply do not exist in any other organization, anywhere.

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Job Features

Job CategoryHealthcare, Nursing
PositionPreservice Review Nurse RN
Educational QualificationsBachelor’s Degree preferred
Professional QualificationsUR / UM, previous air ambulance review flight nurse experience NLC (Nurse License Compact) RN license
Previous ExperienceBackground involving utilization review for an insurance company or experience in case management Familiarity with Milliman Care Guidelines Excellent communication skills both verbal and written Demonstrated written proficiency for Spanish
ResponsibilitiesPerform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information Function as a member of a self-directed team to meet specific individual and team performance metrics Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information Acts as a resource for others with less experience Work independently and collaborating with Medical Directors and non-clinical partners Adapt to a highly changing environment and a heavy case load The hours for this position are M-F 9-6 plus ON CALL duties. This team crosses all lines of business, processes, and platforms. The team monitors inpatient admissions, outpatient procedures on the EPAL, facility to facility transfers (foreign hospitals to acute inpt. rehab), and air ambulance (international and domestic) reviews. The air ambulance team has required on call duties and is available 24/7. On-call rotates to one week a month and at times 2 weeks a month due to calendar and/ or PTO. This is a high profile fast paced team with short regulatory requirements and contact with multiple departments, members, vendors and work closely with medical directors.
Preffered QualificationsIf the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years. Demonstrate a proficiency in computer skills – Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel and Outlook Exemplary clinical documentation skills; critical thinking skills Must have a quiet designated work space and access to install secure high speed internet (minimum speed 1.5 download mps & 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement)
LocationTampa, Florida

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