There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)

Want to learn more before applying for this role? Click here to view the Realistic Job Preview: UHC_Telephonic_UM_Nurse.pdf

We're looking for someone like you to join our team as a Telephonic Utilization Management Review Nurse. In this role, you will manage prior authorization requests for our clinical providers. Make a smart career move, and apply now.

***This position is based in our Houston, Texas office and could potentially evolve into a telecommuting role***

Monday - Friday (day shift) 8:30 am - 5:00pm  

Key responsibilities of the Telephonic Utilization Management Review Nurse include:

• Assesses and interprets customer needs and requirements.
• Provides authorizations and/or denials based on clinical documentation review and medical necessity.
• Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
• Collaborates closely with the Medical Director for complex cases. 
• Develops expertise in a managed care plan Utilization Management process.
• Identifies solutions to non-standard requests and problems.
• Solves moderately complex problems and/or conducts moderately complex analyses.

The chosen candidate must possess:

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

We also prefer:

• Utilization management experience
• Acute Care Inpatient experience
• Acute care case management experience
• Knowledge of Milliman and/or Interqual guidelines
• Experience working with Medicare and/or Medicaid

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.

 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.