Preservice Review RN - Pittsburgh, PA - Full-time / Part-time

Are you ready for your next challenge? Discover it here at UnitedHealthcare and help us reinvent the health system. This can be your opportunity to take on a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. You will discuss cases with treating physicians and other healthcare professionals to ensure our members receive the proper health services. You will be required to maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities in order to help patients through their care plan. This is an exciting opportunity at a truly inspired organization. Join us. This can be the start of your life's best work.(sm)

 
What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

As a Preservice Review Nurse your duties will include:

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   Perform utilization and concurrent review using Milliman criteria



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   Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care 



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   Approve bed days for inpatient cases when applicable



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  Arrange alternative care services; Contact and maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum



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  Gather clinical information to assess and expedite care needs 



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  Consult with the Medical Director as needed to troubleshoot difficult or complex cases 

Tuesday - Saturday 8-5

Primary Responsibilities:

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  Determine medical appropriateness of elective admissions and outpatient services following evaluation of medical guidelines and benefit determination



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  Performs medical necessity reviews using medical policies, Milliman, Interqual and Medicare criteria



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   Gathers clinical information needed for medical necessity reviews



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  Maintains appropriate documentation following Prior Auth Standard Operating Procedures



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  Consults with the Medical Director as needed to troubleshoot difficult or complex cases



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   Participates in telephonic and in-person staff meetings
  
  
  
  

Required Qualifications:

• Unrestricted, active RN license


• 3 years RN experience in an acute setting


• Ability to create, edit, save and send documents utilizing Microsoft Word. Ability to navigate a Windows environment, Microsoft Outlook, and conduct Internet searches

Preferred Qualifications:

• Undergraduate degree (BSN) or equivalent experience 


• Background in discharge planning and/or chart review


• Utilization management, prior authorization, and case management experience


• Working knowledge of Milliman and/or InterQual


• Ability to build and maintain relationships

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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)

Diversity creates a healthier atmosphere: 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: RN, registered nurse, Pittsburgh, PA, Prior authorizations, utilization management, united health group