Global insurance Clinical Care Manager - Bilingual Japanese RN - Remote

Overview

At United Healthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together
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The Global Insurance Clinical Care Manager - Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States.

This is a 24/7 operation. While your primary schedule will follow the hours listed below, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation.

Youll have the flexibility to work remotely from anywhere within the U.S. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

This position supports the Eastern time zone (EST) which is 3:00pm–11:00pm. If you reside in the Central time zone (CST) hours would be 2:00pm–10:00pm, in the Mountain time zone (MST) 1:00pm–9:00pm, and in the Pacific time zone (PST) 12:00pm–8:00pm. Monday–Friday with potential to work limited overnight and/or weekend hours based on client or member needs.

• A GI CCM must consider both US and international care standards and regulatory guidelines. They must be able to work in multiple platforms and communicate with members and providers to obtain information needed to perform the clinical review.
• Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches.
• The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims.

• Registered Nurse with an active unrestricted United States license
• Must be bilingual in Japanese and English, with strong verbal and written communication skills
• 3+ years of experience in medical-surgical inpatient acute care
• Experience collaborating with Medical Director to review care plans and make recommendations. Ability to advocate on behalf of the member s needs while considering contractual limitations
• Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals
• Proven communication skills at all levels
• Proven ability to be flexible and display a positive attitude
• Proven solid problem-solving, organizational and crisis management skills
• Proven ability to function confidently and efficiently in a fast-paced work environment
• Proven ability to foster team cohesion in an international virtual environment
• Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations
• Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members
• Proven advanced software skills with ability to work in multiple platforms with clinical case reviews
• Proven advanced skills with Microsoft Office - Excel, Word
• Ability to work in the Eastern time zone (EST) which is 3:00pm–11:00pm. If you reside in Central time zone (CST) hours would be 2:00pm–10:00pm, in the Mountain time zone (MST) 1:00pm–9:00pm, and in the Pacific time zone (PST) 12:00pm–8:00pm. Monday–Friday with potential to work limited overnight and/or weekend hours based on client or member needs

• Bachelor s degree
• 2+ years of experience in utilization management or case management in a managed care or hospital environment
• Experience in international healthcare and/or air medical transport
• Experience in discharge planning…