The job below is no longer available.
You might also like
in Nashville, TN
- $36
est. per hour Ascension • 5d agoUrgently hiring 1.7 mi Use left and right arrow keys to navigate - $24
est. per hour Ascension • 3d agoUrgently hiring 1.7 mi Use left and right arrow keys to navigate 
$2,000Verified per week CareerStaff Unlimited • 2d agoUrgently hiring Use left and right arrow keys to navigate- $2,000
Verified per week CareerStaff Unlimited • 2d agoUrgently hiring Use left and right arrow keys to navigate 
$36est. per hour TriStar Centennial Medical Center • 2d agoUrgently hiring 1.3 mi Use left and right arrow keys to navigate
Preservice Review Nurse RN - Telecommute
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Nashville, TN Nashville, Tennessee |
About this job
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.
Primary Responsibilities:
- Perform prior authorizations, utilization and concurrent reviews using Milliman criteria
- Prior to service, discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care and medical necessity
- Approve bed days for inpatient cases when applicable
- Prior authorizations for alternative care services including contacting and maintaining communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum
- Gather clinical information to assess and expedite care need approvals
- Consult with the Medical Director as needed to troubleshoot difficult or complex cases
- Other duties as assigned
Requirements
Required Qualifications:
- A current, unrestricted RN license
- 3+ years of RN experience in an acute setting or related RN clinical experience
- MS Office proficiency including the ability to create, edit, save and send documents utilizing Microsoft Word and Outlook
- Ability to navigate in a Windows environment and conduct Internet searches
- Must have a designated work space and access to install secure high speed internet via cable/DSL in home
Preferred Qualifications:
- BSN
- Utilization management, prior authorization, and/or case management experience highly preferred
- Working knowledge of Milliman and/or InterQual criteria
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: Utilization review, utilization management, RN, Telecommute, Work from home, LA, Louisiana