Remote MSK Preauthorization Nurse – Review & Care Impact

University of Minnesota School of Nursing; Minnetonka, Northern (MN, KY); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking an experienced Nurse Specialist for Pre-Authorization to review MSK care requests and determine medical necessity. The role involves evaluating documentation, assessing service appropriateness, and coordinating with involved parties to manage cases. Flexible schedule with remote work within the U.S.

is available. Required qualifications include an active nursing license, 3+ years of experience (1+ in MSK or pre-authorization), and proficiency with computer

Qualifications

• Associates, Bachelors or equivalent in Nursing.
• Current and active unrestricted Nursing License or certification.
• 3+ years of experience, with 1+ years of Musculoskeletal, or Pre-Authorization related experience.
• Knowledge of CMS, InterQual or equivalent clinical criteria.
• Proficiency in operating computer applications.
• Willing to work occasional Saturdays if requested by the business.

Responsibilities

• Review MSK care requests to determine medical necessity or refer to Medical Directors.
• Review documentation to support medical necessity of the request.
• Assess medical appropriateness of inpatient and outpatient services per guidelines.
• Maintain contact with involved parties for case management.
• Adhere to documentation and performance guidelines.
• Interpret customer needs and requirements and identify solutions.
• Work with minimal guidance; seek guidance on complex tasks.

Skills

Nursing

CMS/InterQual knowledge

Computer skills

Flexible schedule

Education

Associates or Bachelor's in Nursing

Tools

EMR systems

Job description

UnitedHealth Group is seeking an experienced Nurse Specialist for Pre-Authorization to review MSK care requests and determine medical necessity. The role involves evaluating documentation, assessing service appropriateness, and coordinating with involved parties to manage cases. Flexible schedule with remote work within the U.S.

is available. Required qualifications include an active nursing license, 3+ years of experience (1+ in MSK or pre-authorization), and proficiency with computer