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Utilization Management Nurse RN - Telecommute U.S. - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Plano, TX Plano, Texas |
About this job
We're looking for someone like you to join our team as a Telephonic RN Pre-service Review Nurse. In this role, you will review inpatient stays, outpatient therapy and treatments, diagnostics such as MRI's and CT's, home health, DME and other services to ensure the correct level of care is provided. Additionally, you will provide authorizations and/or denials based on clinical documentation review and medical necessity. Make a smart career move, and apply now...
Want to learn more before applying for this role? Click here to view the Realistic Job Preview:
Primary Responsibilities:
- Reviewing patient cases for medical necessity
- Reviewing requests for inpatient stays, outpatient treatment as well as for various procedures such as bariatric and spinal surgeries, MRI's, CAT scans, home health care etc.
- Obtaining patient clinical and make decisions using Milliman-based care criteria
- Documenting patient clinical information into our systems
Requirements
Required Qualifications:
- A current, unrestricted RN license
- 3 or more years of clinical RN nursing experience: inpatient, outpatient clinic etc.
- Advanced PC proficiency, to include MS Word and Outlook, and the ability to type and talk at the same time
- Must have a designated work space in home and access to secure high speed internet via cable/DSL.
Preferred Qualifications:
- Utilization management experience
- Prior Authorization experience
- Discharge planning experience
- Case management experience
- Knowledge of Milliman Care guidelines highly preferred
- BSN Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 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, Case Management, Utilization Management, Utilization Review, CM, UR, UM, Pre Authorization, Nurse, Nursing, Clinical, Clinic, Inpatient, Outpatient, Telecommute, Work from home
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