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UnitedHealth Group

Onsite RN Case Manager - Optumrx - Workers Compensation - Philadelphia, PA - 726542

UnitedHealth Group - Philadelphia, PA

Position Description Responsible for providing medical case management for the Workers Compensation Department. Reviews treatments plans based on causality and medical necessity. Primary Responsibilities: Ensures accuracy, quality and timeliness of reviews are in accordance with PA regulations and departmental policy and procedures and account protocols Ensures all notices are accurate and processed timely in accordance with PA regulations and departmental policy and procedures and account protocols Reviews and evaluates all medical correspondence received Identifies approved services appropriate for referral to various vendors according to account specific protocols and properly completes the referral according to departmental policy and procedures and account protocols Reviews the claim treatment history with internal and external contacts in accordance with PA regulations and departmental policy and procedures and account protocols Evaluates clinical file and ensures treatment is causally related and medically necessary Adheres to cost savings measures and departmental and company-wide Quality Assurance programs Holds to the philosophy and standards of quality as outlined by Optum. Adheres to statutory regulations, HIPPA compliance, account protocols and department policy and procedures Prepares comprehensive summaries following determinations or after significant activity occurs on the file in accordance with departmental policy and procedures and account protocols Maintains the integrity of RMS system at all times and adheres to all electronic paperless workflows Attends in-service meetings and continuing education seminars as appropriate May act as preceptor for TCMs as directed by management Requirements To be considered for this position, applicants need to meet the qualifications listed in this posting. Required Qualifications: Valid PA driver’s licenseWorkers compensation case management experience Proficient computer skills including typing and Microsoft Office software Excellent communication, interpersonal and organizational skills Excellent time management skillsProfessional phone etiquettePreferred Qualifications: Valid PA RN license 2 years of related case management experience Understanding of PA regulations, managed care and insurance terminologyCareers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)  Diversity creates a healthier atmosphere: 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: case manager, case management, medical case manager, RN, LPN, Philadelphia, PA, Pennsylvania

8 days 18 hours ago

UnitedHealth Group

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Onsite RN Case Manager - Optumrx - Workers Compensation - Philadelphia, PA - 726542 UnitedHealth Group - Philadelphia, PA, United States

   

Location: Philadelphia, PA

Company Profile:
About UnitedHealth Group UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone. We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term