RN MSK Preservice Review Nurse Remote

Lensa • Full-time • Remote (Eden Prairie, MN, US) • $28 - $50 / hour • 1w ago

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for UnitedHealth Group. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice.

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

Undergraduate degree or equivalent experience
Current and active unrestricted Nursing License or certification
Must be willing to work an occasional Saturday if requested by the business
3+ years of experience, with 1+ years of Musculoskeletal, Case Management, or Pre-Authorization related experience
Proven knowledge of the clinical criteria (e.g. CMS, InterQual, etc.).
Proficiency in operating computer applications

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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

If you have questions about this posting, please contact support@lensa.com