Pre-Service Review Nurse RN-Remote in PST or MST-California RN License
About the position For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Pre-Service Review Nurse RN at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You'll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact? Although this position is remote, applicants must be located in Pacific or Mountain Time Zones. Standard work week is Mon-Fri 8-5 PST or MST. There will be 2 weekend shifts required per month either one weekend or one day two separate weekends. Responsibilities • Function is responsible for utilization management which includes Prior Authorization Review of skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospital. • Determines medical appropriateness of level of care following evaluation of medical guidelines and benefit determination. • Generally, work is self-directed and not prescribed. • Works with less structured, more complex issues. • Identify solutions to non-standard requests and problems. • Translate concepts into practice. • Act as a resource for others; provide explanations and information on difficult issues. Requirements • Unrestricted RN License in the state of California and in your state of residence (if primary residence is not in California). • 3+ years of Clinical Nursing experience. • 1+ years of Utilization Review and/or Prior Authorization experience within a Managed Care environment. • Proven basic computer skills with MS Outlook, Word and Excel. • Primary residence in Pacific or Mountain Time Zone. • Ability to work Mon-Fri 8-5 PST or MST and at least 2 weekend days per month. Nice-to-haves • Multi-Specialty experience. • Experience in a skilled nursing facility, LTAC or inpatient rehabilitation facility. • Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance. • Knowledge of Milliman Criteria (MCG). • Knowledge of Medicare Criteria. Benefits • Comprehensive benefits package. • Incentive and recognition programs. • Equity stock purchase. • 401k contribution. Apply tot his job