Preservice Review Nurse RN - Remote

In this role, you'll discuss cases with treating physicians and other health care professionals to ensure our members receive the proper health services. You'll also stay in touch with acute long-term care, acute rehabilitation or skilled nursing facilities to help patients through their care plan.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language and consideration of relevant clinical information
• Communicate all types of benefit determinations, including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations
• Speak to health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
• Act as a resource for others with less experience
• It feels great to have autonomy and there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact our members. And at the same time, you'll be challenged by leveraging technologies and resources in a rapidly-changing, production-driven environment

Required Qualifications

• Current unrestricted RN license in the state of residency
• 3+ RN years of experience, including experience in an inpatient/acute setting
• Designated homework space and access to install secure high-speed internet via cable/DSL

Preferred Qualifications

• Bachelor's Degree
• Background involving utilization review for an insurance company or experience in case management
• Ability to use your diverse knowledge and experience to make health care work better for our patients
• Familiarity with Milliman Care Guidelines

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The hourly pay for this role will range from $29.00 - $52.00 per hour based on full-time employment.