Preservice Review Nurse RN - Remote

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

Job summary

UnitedHealth Group is seeking a Preservice Review Nurse RN to manage a range of healthcare services in outpatient and inpatient settings, collaborating with clinical teams to improve patient outcomes. This role supports a dynamic, remote-friendly environment and offers a full-time day shift.

You will perform initial and ongoing reviews for PA, ICM, DCM, and PACM, apply InterQual criteria, liaise with Medical Directors and Health Plan partners, and ensure adherence to SOPs while maintaining

Qualifications

• Current, unrestricted RN license in state of residency.
• 3+ years RN experience.
• Residency must be in the U.S.

Responsibilities

• Perform initial and ongoing reviews for Prior Authorization (PA), Inpatient Care Management (ICM), Discharge Care Management (DCM), and Post-Acute Care Management (PACM).
• Apply clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and send to Medical Directors if necessary.
• Collaborate with Medical Directors, clinical peers, and Health Plan partners on clinical decision-making and referrals.
• Apply clinical expertise when discussing cases with internal and external Case Managers and Physicians.
• Follow all Standard Operating Procedures in end-to-end management of cases.
• Participate in team meetings, education discussions, and related activities.
• Maintain compliance with Federal, State, and accreditation organizations.

Skills

RN experience

Review/authorization

InterQual criteria

Education

RN license

Job description

About This Role

The Preservice Review Nurse RN will manage a variety of healthcare services in both outpatient and inpatient settings, collaborating with specialized clinical teams to improve patient outcomes. This role is ideal for experienced RNs looking to work in a dynamic, remote environment.

Highlights

• Pay: $29 - $52/hour
• Location: Phoenix, AZ
• Schedule: Full Time, Day shift
• Residency: Must reside in the U.S.

What You'll Do

• Perform initial and ongoing reviews for Prior Authorization (PA), Inpatient Care Management (ICM), Discharge Care Management (DCM), and Post-Acute Care Management (PACM).
• Apply clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and send to Medical Directors if necessary.
• Collaborate with Medical Directors, clinical peers, and Health Plan partners on clinical decision-making and referrals.
• Apply clinical expertise when discussing cases with internal and external Case Managers and Physicians.
• Follow all Standard Operating Procedures in end-to-end management of cases.
• Participate in team meetings, education discussions, and related activities.
• Maintain compliance with Federal, State, and accreditation organizations.

Requirements

Education:

• Current, unrestricted RN license in state of residency

Experience:

• 3+ years of RN experience

Licenses & Certifications:

• Current RN License in state of residency required

About UnitedHealth Group

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