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Prior Authorization RN - Telecommute

Company: UnitedHealth Group
Location: Great Falls
Posted on: January 8, 2022

Job Description:

The Integrated Care Team is a cross-functional approach, supporting the member end to end, with close collaboration and co-management. The team will manage the full array of health care services, spanning both outpatient and inpatient settings and with support from some specialized clinical teams. This new cross-functional collaboration provides an opportunity to deliver the next generation clinical model, integrating services from precertification, inpatient concurrent review, discharge planning, care management and prevention to improve quality of care and patient outcomes.
The Prior Authorization/Preservice Review RN role will be performing inpatient clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information.


If you have a Washington State RN licensure, you will have the flexibility to telecommute* as you take on some tough challenges. Required hours are Monday - Friday: 8:00am to 5:00pm or 8:30am to 5:30pm.
Primary Responsibilities:


  • 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 Washington

    • 3+ years of experience as a Registered Nurse (RN)

    • 3+ years of experience as a RN in a hospital inpatient/acute care setting

    • Demonstrate a proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms

    • Designated workspace and access to install secure high-speed internet via cable/fiber optic
      Preferred Qualifications:

      • Bachelor's Degree

      • Preservice Review/Prior Authorization experience

      • Utilization Management/Utilization Review experience

      • Experience in discharge planning and/or chart review

      • Familiarity with InterQual or MCG criteria guidelines

      • Medical necessity reviews

      • Familiarity with CMS guidelines/regulations

      • Familiarity with Medicaid guidelines/regulations
        To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
        Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
        Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $53,300 to $95,100. The salary range for Connecticut/Nevada residents is $58,800 to $104,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

        • 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.
          Keywords: RN, Registered Nurse, Prior authorization, preservice review, medical necessity review, utilization management, utilization review, managed care, outpatient, acute care, hospital inpatient, chart review, InterQual, MCG, Milliman, CMS, Medicaid, telecommute, work from home, remote, Washington, WA

Keywords: UnitedHealth Group, Great Falls , Prior Authorization RN - Telecommute, Healthcare , Great Falls, Montana

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