UnitedHealth Group

University Of Richmond, VA

Preservice Private Duty Review Nurse - RN - Telecommute - VA - 727800

Posted over 1 month ago · Full time

Job Description

Position Description
Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)
As a Preservice Private Duty Review Nurse, you will support the MLTSS program in the state of VA and will review PDN services for children under age 21 in accordance with the State criteria. This position may require the individual to work with state partners in private duty nursing workgroups.  Responsible for performing pre-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria.
This individual will serve as the plan’s subject matter expert with private duty nursing services and assist the care team with contributing to the individualized care plan.  You may also act as an intermediary between providers and members- serving in numerous roles, such as education, evaluator, coordinator, community resource researcher and more.
What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
Primary Responsibilities:
  • Review  clinical request for Private Duty nursing  service for Medicare and / or Medicaid members
  • Assist and collaborate with care team such as, participation in Interdisciplinary care team meetings to evaluate members care needs
  • Assess and interprets customer needs and requirements
  • Identify solutions to non-standard requests an problems
  • Solve moderately complex problems and / or conducts moderately complex analysis
  • Works with minimal guidance, seeks guidance on complex tasks
  • Provide a complete continuum of quality care through following establish guideline and contractual requirements

To be considered for this position, applicants need to meet the qualifications listed in this posting.
Required Qualifications:
  • Current and unrestricted Registered Nurse License  in the state of Virginia or hold a multi-state license recognized by Virginia
  • 1+ years Utilization Management experience
  • 1+ year Case Management experience
  • 3+ years clinical experience in a hospital, acute care, home health / hospice, direct care or case management
  • Ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
  • Proficient computer skills in Microsoft Office, to include Excel, Word, Outlook and the ability to type and talk at the same time and toggle between multiple screens
  • Reliable transportation to travel to member homes or other locations within service delivery are

Preferred Qualifications:

  • Certification in Case Management
  • Home care / Hospice experience
  • Medicaid, Medicare, Managed Care experience
  • Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
  • Bilingual skills
  • Experience in Home & Community based or Long Term Care services delivery

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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: RN, nurse, case manager, CCM, Medicaid Waver, behavioral health, VAMLTSS, public health, community health, long term care, home care, care coordination, home health, complex case management, managed care, private duty nurse, utilization management, UM, Richmond, Virginia, VA

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