***This position is based in our Houston, Texas office and could potentially evolve into a telecommuting role after a year if all job standards are met***

Monday - Friday Days - 8:00- 4:30 OR 8:30-5:00

Key responsibilities of the Preservice Review Nurse include:

• Provides authorizations and/or denials based on clinical documentation review and medical necessity.
• This positions focus will involve and support Manage Long Term Care program, homecare and personal care program activities to include pre-authorizations of and concurrent review of medically necessary services.
• Collaborates closely with the Medical Director for complex cases.
• Develops expertise in a managed care plan Utilization Management process.
• Assesses and interprets customer needs and requirements
• Identifies solutions to non-standard requests and problems.
• Solves moderately complex problems and/or conducts moderately complex analyses.

What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you’ll open doors for yourself that simply do not exist in any other organization, anywhere.

The chosen candidate must possess:

• A current, unrestricted RN license in Texas
• 3 years clinical experience   
• MUST be PC proficiency, to include MS Word, Excel and Outlook and the ability to type and talk at the same time

We also prefer:

• Utilization management and/or Prior Authorization experience
• Experience with a managed care company
• Case management experience
• Knowledge of Milliman and/or Interqual guidelines  
• Experience in an acute care, HHC/Hospice, LTC, acute rehab, or SNF
• Medicaid and/or Medicare knowledge

UnitedHealth Care Community and State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

When you work with UnitedHealth Care Community and State, what you do matters. It's that simple...and it's that challenging.

In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.

 Regardless of your role at UnitedHealth Care Community and State, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.