6 hours

Preservice Review Nurse RN - Telecommute - West Coast / PST preferred

UnitedHealth Group
  • Job Code
  • Jobs Rated
775933 Preservice Review Nurse RN Telecommute West Coast PST preferred

Preservice Review Nurse RN - Telecommute - West Coast / PST preferred (775933)

Position Description

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.
***Every other weekend is required both Saturday and Sunday, and then that week you get 2 days off during the week*** 
***Hours will be 8:00am-4:30pm PST***
If you are located in West Coast time zone / Pacific time, you will have the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities:
  • Perform medical necessity review for services that require prior authorization utilizing specific criteria
  • Discuss cases with treating physicians and other healthcare professionals to gather necessary information in order to review the requested services or to give verbal determination on a case
  • Request clinical information necessary to review requested services
  • Consult with the Medical Director as needed to troubleshoot difficult or complex cases
Required Qualifications:
  • Active, unrestricted RN license in your state of residence
  • 3+ years of clinical experience (any setting)
  • Previous experience in Prior Authorizations or related function (case management, utilization review, coverage determination, etc.)  
  • Ability to create, edit, save and send documents utilizing Microsoft Word.  Ability to navigate a Windows environment, Microsoft Outlook, and conduct Internet searches
  • Ability to be flexible and work in a fast - paced environment
  • Able to work every other weekend both Saturday and Sunday
Preferred Qualifications:
  • BSN
  • Knowledge of ICD10 and CPT coding
  • Knowledge of Milliman Care Guidelines
  • Knowledge of Medicare guidelines and regulations
  • Detail oriented, self - sufficient and decisive
  • Excellent organizational and communication skills
  • Sound decision making ability

Use your diverse knowledge and experience to make health care work better for our patients. Join us in reshaping health care while doing your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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, nurse, pre-service, prior authorizations, utilization review, utilization management, case management, coverage determination, Medicare, Nevada, NV, California, CA, Oregon, OR, Washington,  WA, West Coast, PST

Job Details

  • Contest Number775933
  • Job TitlePreservice Review Nurse RN - Telecommute - West Coast / PST preferred
  • Job FamilyNursing
  • Business SegmentOptum Operations

Job Location Information

  • CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusNon-exempt


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Preservice Review Nurse RN - Telecommute - West Coast / PST preferred

UnitedHealth Group

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UnitedHealth Group

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