RN MSK Preservice Review Nurse Remote

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

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Review of Musculoskeletal (MSK)care requests to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria
• Review documentation submitted to support the medical necessity of the request
• Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
• Maintains contact with all parties involved in case necessary for case management for the client
• Adheres to all documentation and performance guidelines
• Assesses and interprets customer needs and requirements
• Identifies solutions to nonstandard requests and problems
• Works with minimal guidance; seeks guidance on only the most complex tasks

You’ll 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:

• 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 the clinical criteria (e.g. CMS, InterQual, etc.)
• Proficiency in operating computer applications
• Willing to work an occasional Saturday if requested by the business

Preferred Qualifications:

• Medicare Pre-Authorization experience
• Managed Care experience
• Proven excellent interpersonal skills
• Proven excellent verbal and written communications skills

*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’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution

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.

UnitedHealth Group 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.

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