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UnitedHealth Group Medical Management Clinic Rev - Physical Therapy - Pediatrics preferred - North Carolina resident - Telecommute (virtual) in Winston-Salem, North Carolina

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work. (sm)

As a member of this dynamic team, you will manage the medical necessity of durable medical equipment request.

If you are located in Central, Mountain, or Arizona time zone, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Make determinations of medical necessity/clinical appropriateness of treatment

  • Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community

  • Be knowledgeable on and apply all necessary regulatory requirements for assigned regions

  • Responsible for appropriate utilization management (prospective, concurrent and retrospective) and implementation of healthcare affordability initiatives in all the UnitedHealthcare regions

  • Uses pertinent data and facts to identify and solve a range of problems within area of expertise.

  • Investigates non-standard requests and problems, with some assistance from others.

  • Works exclusively within a specific knowledge area.

  • Prioritizes and organizes own work to meet deadlines.

  • Provides explanations and information to others on topics within area of expertise.

  • Works under the supervision of a physician. Nurse manager

  • Positions are responsible for providing appropriately focused Medical Management Clinical Review of the activities listed below, in support of physician activities, and in accordance with specific review protocols, based on individual member plan documents, national and proprietary coverage review guidelines, and established clinical review guidelines.

  • Preservice and Retrospective coverage determinations, and/or

  • Appeals for services that have been denied.

  • Uses technical knowledge and related review protocols in the review of clinical information and documents as they relate to Company medical policy and benefit document language. Under the direct oversight of physicians or non-physician clinicians, may recommend clinical appropriateness of designated services.

Required Qualifications:

  • Unrestricted license Physical Therapy in your state of residence

  • 3+ years’ experience in Physical Therapy working with diverse populations, Special Needs Populations, Pediatrics, and General population adult

  • Proficiency in MS Office

  • Strong decision-making and administrative skills

  • Strong knowledge of practice guidelines, including office procedures, current research and scope of practice

  • Ability to interpret guidelines, research, etc. in the context of traditional Physical Therapy practice

  • Strong written and verbal communication skills

  • Ability to be consultative with others including supervisory, clinical and non-clinical professionals

Preferred Qualifications:

  • Previous experience in a managed care environment (health plan, medical group, etc.)

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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: Physical Therapy, Utilization Review, Therapy, Therapist, Medicaid, ASHA, Telecommuting, Preservice, Preservice Review, Virtual