Remote Oncology RN: Telephonic Case Review Specialist

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

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