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Nursing careers at UnitedHealth Group are anything but ordinary. There’s an energy and excitement here, a shared mission to improve the lives of others as well as our own. A passion for excellence you won’t find anywhere else. We ask tough questions. We push ourselves and each other to find smarter solutions. The result is a culture of performance that’s driving the health care industry forward. Nursing here isn’t for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Learn more, and start doing your life’s best work.SM

RN Supervisor Utilization Management for WellMed - San Antonio, TX

Job Description:

Be a part of a growing team!

 

This position will have to rotate Saturdays as part of the schedule.


The Supervisor Utilization Management  is responsible for utilization management which includes Concurrent Review and Prior Authorizations. (Telephonic Inpatient Care Management).


Performs reviews of current inpatient services. Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.


Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit.

Job Requirements:

  • Current unrestricted RN licensure in applicable state.

  • Undergraduate degree or equivalent experience.

  • Previous supervisory experience

  • 2 years managed care experience or 5 years as an RN

  • 2+ years previous Utilization Management/Prior Authorization experience

  • Good understanding of sorting and filtering data in Excel spreadsheets.

  • Working knowledge of Medicare benefits and rules


Preferred Experience and Skills


  • Previous Utilization Management Supervisory experience




WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services.  Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.


Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness.  We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors.  Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.


WellMed is now part of the OptumHealth division under the greater UnitedHealth Group umbrella.



Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
 

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.


keywords: rn, registered nurse, prior authorization, um, utilization management, rn supervisor, rn manager, sa, san antonio, tx

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Job Category: Nurse
Insurance
Health Care
Job Reference Code: UHG-541858
Position Type: Full-Time
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  • RN Supervisor Utilization Management for WellMed - San Antonio, TX @ UnitedHealth Group

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