Remote Preservice Review RN - Coverage & Compliance

UnitedHealth Group; Oklahoma; Remote; USD 40,000 - 72,000; Full time

Benefits offered by this job

Benefits package

Incentives and recognition

Equity stock purchase & 401k

Job summary

UnitedHealth Group is seeking a Preservice Review Nurse RN to perform clinical coverage reviews and interpret state and federal mandates while working remotely from Tulsa, OK. The role emphasizes strong documentation and clear communication of benefit determinations to providers and members.

The position requires 2+ years of RN experience, inpatient/acute care exposure, and a current Oklahoma RN license, with a compact license preferred.

Qualifications

• 2+ years of RN experience, including experience in an inpatient/acute setting.
• Professional experience in direct patient care.
• Background involving utilization review for an insurance company or experience in case management preferred.

Responsibilities

• Perform clinical coverage review services, interpreting state and federal mandates and applicable benefit language.
• Function as a member of a self-directed team to meet specific individual and team performance metrics.
• Communicate in writing and verbally all types of benefit determinations, including decisions regarding coverage guidelines.
• Engage in telephonic discussions with healthcare providers and/or members to explain benefit coverage determinations and obtain additional clinical information.
• Act as a resource for others with less experience.
• Work independently while collaborating with Medical Directors and non-clinical partners.
• Adapt to a highly changing environment and manage a heavy case load.

Skills

RN experience

Clinical documentation

Communication skills

Education

Bachelor's degree

Job description

UnitedHealth Group is seeking a Preservice Review Nurse RN to perform clinical coverage reviews and interpret state and federal mandates while working remotely from Tulsa, OK. The role emphasizes strong documentation and clear communication of benefit determinations to providers and members.

The position requires 2+ years of RN experience, inpatient/acute care exposure, and a current Oklahoma RN license, with a compact license preferred.