Looking for a way to influence the health and healthcare of many?
If so, we’d love to hear from you! Our mission-driven organization is focused on the“Triple Aim” - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.
UNITE HERE HEALTH serves 90,000+ workers in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!
The Medical Management department is participant focused and strives to provide the best possible care for the participants through Utilization Review and Utilization Management services, Care Coordination and Population Health Management. The Medical Management department also assists participants in receiving care with specialists outside the service area when appropriate. The Department is designed to ensure the delivery of high quality, cost efficient healthcare for our participants and families through coordinating care, providing detailed discharge plans, advising participants of different programs available and providing face-to-face and telephonic education.
The Utilization Review Nurse is responsible for conducting utilization management activities in accordance with Utilization Management policies and procedures. The position responsibilities include the management of medical costs through timely prospective, concurrent and retrospective review activities. The Utilization Review Nurse promotes exceptional customer service by providing outreach to participant and families as well as providers as providers.
Years of Experience and Knowledge
Education, Licenses, and Certifications
Skills and Abilities