Musculoskeletal Orthopedic Care Manager

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.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• 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

Required Qualifications:

• Current, unrestricted RN license in your State of Residence. (May be willing to consider equivalent work experience in lieu of RN License.)
• 5+ years of hands on clinical experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
• 1+ years of Musculoskeletal and / or Orthopedic experience in a Case Management or Prior Authorization role
• Demonstrate a proficiency in computer skills including Microsoft Word, with the ability to navigate a Windows environment
• Strong written and verbal communication skills
• Attention to detail, organizational skills and multitasking abilities will be keys to success
• Must have a designated work space and access to install secure high speed Internet via cable / DSL in home

Preferred Qualifications:

• BSN
• Pain Management experience
• Certified Case Manager (CCM)
• Telephonic case management experience
• Milliman (MCG), CMS and / or InterQual experience
• Utilization review and/or prior authorization experience
• Managed Care
• Compact RN license
• Willing and able to obtain additional State RN Licensure(s), if necessary

Answer the call to use your diverse knowledge and experience to make health care work better for our patients. Join us and start doing your life’s best work.(sm) UnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we’re doing a lot of good.

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy