Preservice Review Nurse RN - Telecommute - Tues- Sat work schedule - 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.
 
Primary Responsibilities:

Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
Function as a member of a self-directed team to meet specific individual and team performance metrics
Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations
Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
Acts as a resource for others with less experience
Work independently and collaborating with Medical Directors and non-clinical partners
Adapt to a highly changing environment and a heavy case load

Required Qualifications:


A current unrestricted RN license in the state of residency
Minimum of 3 years total RN experience including recent clinical experience in an inpatient/acute setting
Demonstrate a proficiency in computer skills – Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel and Outlook
Exemplary clinical documentation skills; critical thinking skills
Must have a designated work space and access to install secure high speed Internet via cable/DSL in home
 Preferred Qualifications:

Bachelor’s Degree
Background involving utilization review for an insurance company or experience in case management
Familiarity with Milliman Care Guidelines
Excellent communication skills both verbal and written
Demonstrated written proficiency for Spanish
For all FL candidates, this position requires AHCA level II background checks (fingerprinting) by the state of FL for all clinicians that have face to face contact with members or access to confidential patient data and will require renewal every five years.
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.
 
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