UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Preservice Review Nurse RN
Location
United States
Posted
6 days ago
Salary
$29 - $52 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Preservice Review Nurse RN
UnitedHealth Group
Role Description Positions in this role are responsible for Women’s Health/ Gender Dysphoria/ Genetics clinical reviews and require a current, unrestricted RN nursing license in the applicable state. Individual is responsible for performing pre-service clinical coverage review of outpatient Women’s Health/ Gender Dysphoria/ Genetics services which require notification or requested pre-determination, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. If you reside in TN, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: - Perform clinical reviews, which require decision making related to interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information. - Ability to make appropriate clinical decisions within a business environment. - Serve as a member of a team with specific individual and team performance metrics. - Communicate in writing and verbally, all forms of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations. - Work independently and collaboratively with Medical Directors and other business partners. - Flexibility to adapt to changing environment and varied case volume. - Other duties as assigned by leadership. Qualifications - Active, unrestricted Registered Nurse license through the State of Tennessee. - 3+ years of RN patient care experience. - Proficiency working with Microsoft Office Products including Microsoft Outlook, Microsoft Word, and Microsoft Excel. - Reside in Tennessee. Requirements - Bachelor's degree (preferred). - Background involving utilization review or experience in case management, or previous experience with clinical claim review (preferred). - Familiarity with utilizing clinical guidelines (i.e.; Medicare, state, MCG or InterQual) (preferred). - Proven solid clinical judgement while applying medical necessity based on approved clinical resources (preferred). Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). - Hourly pay for this role will range from $29.00 - $52.00 per hour based on full-time employment.
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