Medication Oncology RN - Remote

UnitedHealth Group; Illinois; Remote; USD 83,097,000 - 149,001,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase & 401k

Job summary

UnitedHealth Group is seeking a Telephonic Oncology Preservice Review Nurse to perform pre-service clinical coverage reviews of services requiring notification, using benefit plan documents and clinical guidelines. This fully remote position supports oncology care and strives to improve health outcomes.

The role requires an active RN license, 3+ years in radiation oncology, and the ability to navigate federal/state regulations while prioritizing urgent cases and ensuring accurate coding and

Qualifications

• RN license required (current, unrestricted).
• 3+ years of radiation oncology experience as a nurse.
• Oncology experience preferred.

Responsibilities

• Determine case assignment for review (Medicare, Medicaid, Commercial).
• Validate whether cases require additional research.
• Identify resources for non-clinical research.
• Prioritize cases based on urgency and dates of service.
• Ensure compliance with federal/state requirements and mandates.
• Review clinical records for relevance and accuracy.
• Request additional documentation as needed.
• Review and validate codes for relevance and accuracy.
• Apply medical terminology to interpret records.
• Make determinations per established protocols.
• Review care coordinator notes as appropriate.
• Identify information needed for medical determinations.
• Use medically accepted resources for clinical research.

Education

RN license (Current, unrestricted)

Job description

About This Role

As a Telephonic Oncology Preservice Review Nurse, you will perform pre-service clinical coverage reviews of services requiring notification, utilizing benefit plan documents and clinical guidelines. This fully remote position is ideal for those with a strong background in oncology and a desire to improve health outcomes.

Highlights

• Pay: $29 - $52/hour
• Location: Downers Grove, IL
• Schedule: Full Time, Tuesday through Saturday, 8 AM - 5 PM in your time zone
• Residency: Must reside in the U.S.

What You'll Do

• Determine case assignment to the appropriate team for review (e.g., Medicare, Medicaid, Commercial)
• Validate that cases/requests for services require additional research
• Identify and utilize appropriate resources for non-clinical research
• Prioritize cases based on appropriate criteria (e.g., date of service, urgent, expedited)
• Ensure compliance with applicable federal/state requirements and mandates
• Review/interpret clinical/medical records submitted from providers
• Identify missing information from clinical/medical documentation and request additional documentation as needed
• Review and validate diagnostic/procedure/service codes for relevance and accuracy
• Identify and validate usage of non-standard codes as necessary
• Apply understanding of medical terminology and disease processes to interpret medical/clinical records
• Make determinations per relevant protocols (e.g., approval, denial process)
• Review care coordinator assessments and clinical notes as appropriate
• Identify relevant information needed for medical or clinical determinations
• Identify and utilize medically-accepted resources for clinical research

Requirements

Education

• Current, unrestricted RN license in your state of residence

Experience

• 3+ years of radiation oncology experience as a Nurse
• Oncology experience

Licenses & Certifications

• One of the following licenses required: RN (Registered Nurse) - State Licensure required
• Ability to obtain licensure in other states as needed

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They harness technology and innovation to make care simpler to navigate, more affordable, and more connected for the people they serve. The organization values inclusion and empowers employees to bring their authentic selves to work.