The Prior Authorization RN is responsible for reviewing request received from providers, using approved protocols and criteria (Milliman Care Guidelines or InterQual criteria). The RN is expected to approve those requests that meet medical necessity, along with benefit level, and the contractual status of the provider/facility as appropriate for all full-funded lines of business. In this role you will be expected to send cases that do not meet these requirements to the Medical Director for review. You will also be responsible for maintaining the established productivity standards, along with being within the timeframes required for completion by policy, procedure and all regulatory bodies. The RN is responsible for knowing the policies, procedures, and processes that relate to the position.

 

Job Responsibilities include:

Requirements:

Preferred Assets:

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:

 

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

 

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five

Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry leading businesses.

 

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an

affordable cost.

 

Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.  Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.