Pre-Service Review Nurse RN-Remote in PST or MST-California RN License

UnitedHealth Group; Ontario (CA); Remote; USD 58,000 - 105,000; Full time

Job summary

A healthcare organization is seeking a Pre-Service Review Nurse RN to manage utilization effectively and efficiently. This remote position requires an RN licensed in California with significant clinical experience. The role involves evaluating healthcare services and ensuring compliance with medical guidelines. Strong analytical skills and familiarity with EMR systems are essential. Join a mission-driven team dedicated to improving health outcomes.

Benefits

Comprehensive benefits package

401k contribution

Equity stock purchase

Qualifications

• 3+ years of Clinical Nursing experience.
• 1+ years of Utilization Review and/or Prior Authorization experience.
• Ability to work Mon-Fri 8-5 PST or MST.

Responsibilities

• Responsible for utilization management in healthcare services.
• Evaluate medical appropriateness of level of care.
• Act as a resource for other team members.

Skills

Clinical Nursing experience

Utilization Review

Basic computer skills with MS Outlook, Word and Excel

Education

Unrestricted RN License in California

Tools

EMR systems (Epic, Cerner, etc.)

Job description

For those who want to invent the future of health care, here's your opportunity. We are 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 will 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***

If you are located in Pacific or Mountain time zones, you will have the flexibility to work remotely as you take on some tough challenges.

Primary 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

It feels great to have autonomy, and there's also a lot of responsibility that comes with it. In this role, you will be accountable for making decisions that directly impact our members. And at the same time, you will be challenged by leveraging technologies and resources in a rapidly changing, production-driven environment.

You will be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• 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

Preferred Qualifications

• 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

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you will find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.