- Bachelor’s degree in Nursing, or Associate’s degree in Nursing and Bachelor’s degree in related field, or Associate’s degree in Nursing combined with 4 or more years of experience
- Current, unrestricted RN license required, specific to the state of employment
- Five or more years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
- Two or more years of managed care and / or case management experience
- Knowledge of utilization management, quality improvement, discharge planning, and cost management
- Ability to read, analyze and interpret information in medical records, health plan documents and financial reports
- Ability to solve practical problems and deal with a variety of variables
- Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
- Proficient with Microsoft Office applications including Word, Excel, and Power Point
- Independent problem identification / resolution and decision making skills
- Must be able to prioritize, plan, and handle multiple tasks / demands simultaneously
- Frequently required to stand, walk or sit for prolonged periods
- This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease
- Experience working with psychiatric and geriatric patient populations
- Bilingual (English / Spanish) language proficiency
- InterQual experience or Milliman experience
If 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.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity 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: utilization manager, utilization review, discharge planning, case manager, clinical, managed care, cost management, health care, case management, Ft. Myers, FL, Florida