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Job Details


UnitedHealth Group

Clinical NCLEX Case Manager (Student Resources) - San Juan, PR (107635170)

Human Resources

Human Resources Manager

Yearly

No

San Juan, Puerto Rico, United States

Welcome to one of the most challenging and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. (sm)

The Clinical NCLEX Case Manager Educate others regarding guidelines (e.g., Milliman Care Guidelines, CMS), criteria, and procedures (e.g., cases that meet expedited review guidelines, training internal staff) -Screen or respond to customer requests (e.g., expedited review, training requests, questions regarding rules/guidelines) -Provide feedback/information to internal or external customers (e.g., trends, feedback on prevention of errors, communication of findings) -Educates others around new or existing regulatory requirements -Find answers to basic questions and determine what other information could provide a more complete understanding of the situation.

Optum is committed to ensuring each nurse holds a RN license and is licensed in a member’s state of residence when providing UM/UR in any state that requires it.

Primary Responsibilities:

  • Job Function Description Positions in this function include RN roles (with current unrestricted licensure in applicable state) responsible for providing clinical expertise in any of the following areas:
  • Clinical Interface/Liaison (clinical problem solver with facilities, providers, carriers; resolution of issues concerning members, benefit interpretation, program definition and clarification)
  • Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits)
  • Clinical Training (planning, coordinating, delivering, and evaluating clinical training); - Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
  • Clinical Program Management (development, implementation and/or on-going management and administration of a clinical program(s)
  • Provides strategic oversight and support, measurement standards and revisions as needed for delivery of programs focused on quality, affordability, and outcomes)
  • Anticipates customer needs and proactively develops solutions to meet them
  • Serves as a key resource on complex and/or critical issues
  • Solves complex problems and develops innovative solutions - Performs complex conceptual analyses
  • Reviews work performed by others and provided recommendations for improvement
  • Forecasts and plans resource requirements
  • Authorizes deviations from standards
  • May lead functional or segment teams or projects
  • Provides explanations and information to others on the most complex issues

*** ENGLISH PROFICIENT ASSESSMENT WILL BE REQUIRED AFTER APPLICATION ***

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Valid, active, and unrestricted US RN license (obtained through the NCLEX examination)
  • 1+ years of experience in a hospital, clinical setting, or healthcare company
  • Proficiency with the Microsoft Office Suite (Word, PowerPoint, Excel - create/edit/save documents, and Outlook- email and calendar management)
  • This position is full-time (40 hours/week) Monday- Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (8:00am - 6:00pm AST). It may be necessary, given the business need, to work weekends and/or occasional overtime
  • Professional proficiency in English and Spanish
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Preferred Qualifications:

  • Current Active Compact State License
  • License in any or combination of following states: CA, NV, WA, WY, NM, AND, OK, LA
  • BPO (Business Process Outsourcing) experience related to Clinical Case Management and or Clinical Utilization Management
  • Experience working with Commercial Policies claims and processing

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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: Clinical Coordinator, Clinical Admin, Intake Coordinator, Case Coordinator, Optum, Puerto Rico

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