17 days old

Musculoskeletal Orthopedic Utilization Review RN Case Manager Telecommute

Kingston, NY 12401 Work Remotely
  • Job Code
We're making a strong connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with OrthoNet, a non-integrated entity to UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today!

The OrthoCare Manager is directly responsible to either the Manager or Director of Medical Management depending upon their job location and program that they are managing, and has the administrative responsibility for the overall direction, utilization, supervision, instruction, and examination of the medical care of the member assigned to them.
Primary Responsibilities:
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 
  • Review of Musculoskeletal (MSK) care evaluations and progress reports to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria for either initial or continued authorization
  • Review documentation submitted to support the medical necessity of the request
  • Ensure clinical information submitted for peer review and entered into patient's electronic record is the most accurate and up to date
  • Interacting with the physician to ensure the most appropriate and highest quality of care is recommended
  • Preparation and filing of reports, outcome data, and records needed by OrthoNet
  • Collaborate with Contract Assistants working on their team to ensure that responses to authorization requests are responded to within Regulatory time frames
  • Maintains contact and communicates with insurance companies to apprise them of case activity, case direction or receive authorization services
  • Maintains contact with all parties involved in case necessary for case management for the client
  • Acts as clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to maximize quality of patient care as well as effectively manage length  of stay and utilization resources as appropriate
  • Adheres to all documentation and performance guidelines
  • Other duties as assigned
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.


Posted: 2020-10-08 Expires: 2020-11-07

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.

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Musculoskeletal Orthopedic Utilization Review RN Case Manager Telecommute

UnitedHealth Group
Kingston, NY 12401

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