Clinical Nurse Specialist
4 days ago
UnitedHealth Group is a global organization dedicated to delivering care that improves health outcomes and helps people live healthier lives. As a Clinical Nurse Specialist, you will join our team of skilled professionals who work together to connect patients with the resources and support they need to achieve their best health. In this role, you will utilize your clinical expertise to develop and implement effective care plans, working closely with facility healthcare professionals to improve patient outcomes.
The ideal candidate for this position will have a strong background in nursing and experience in healthcare utilization review. You will be responsible for reviewing patient cases and determining medical appropriateness of services, developing and implementing care plans, and collaborating with Medical Directors to make decisions on adverse determinations. Your exceptional communication skills and ability to work independently will enable you to thrive in this fast-paced environment.
Key Responsibilities:
- Develop and implement comprehensive care plans that address patient needs and goals
- Conduct regular reviews of patient progress and make adjustments to care plans as needed
- Collaborate with Medical Directors to determine medical necessity and make recommendations for further action
- Maintain accurate and detailed records of patient interactions and care plans
Requirements:
- Bachelor's degree in Nursing
- 2+ years of experience in healthcare utilization review or a related field
- Active RN licensure in applicable state
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OR Nurse
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