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UCare

Utilization Review Specialist

This job has now expired

Employer
UCare
Posted
Monday, February 11, 2013
Closes
Thursday, March 7, 2013
Location
Minneapolis, Minnesota
Category
Employment Status

Further information

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota???s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We???re an organization that???s going places. Be part of a team that cares about you, be part of UCare.

The Utilization Review Specialist’s primary responsibilities are to evaluate member specific clinical information against objective, standardized criteria to determine medical necessity, appropriateness and efficiency of specific services the organization has targeted for prior authorization. RN or LPN with requisite experience is required. Current Minnesota nursing license required. 


RN candidate with experience working with state or federally funded programs and one of the following:



  • 3-5 years as staff or charge nurse in hospital, preferably med/surg adults or
  • 2-3 years as staff or charge nurse in hospital and 2-5 yrs long term care experience in Medicare nurse role or
  • 5 years long term care experience and 2-3 years home care nursing or
  • 2-3 years as staff or charge nurse in hospital and 2-3 years home care nursing. 

LPN candidate with experience working with state or federally funded programs and at least one of the following:



  • 5-10 years long term care experience or
  • 3-5 years as staff nurse in hospital, preferably med/surg adults or
  • 2-3 years as staff or charge nurse in hospital and 2-5 yrs long term care experience or
  • 5 years long term care experience and 2-3 years home care nursing or
  • 2-3 years as staff or charge nurse in hospital and 2-3 years home care nursing. 

Knowledge of utilization review standards and experience working with state and federally funded programs. Experience in an HMO or MCO is highly desirable.



At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. EOE/AA

Rewards

Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You???ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis???just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
www.ucare.org/careers/
EOE/AA

UCare

As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. Browse our current openings at www.ucare.org/careers.