Preservice Review Nurse RN

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.

UnitedHealthcare is currently hiring for a Preservice Review Nurse RN in Richardson, TX. The Preservice Review Nurse RN will be responsible for, but not limited to the following duties:

-Assesses and interprets customer needs and requirements.

-Provides authorizations and/or denials based on clinical documentation review and medical necessity.

-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.

-Provides explanations and information to others on difficult issues.

-Coaches, provides feedback, and guides others.

Basic Qualifications:

-Unrestricted, active RN license in Texas

-Minimum of 3 years RN experience in an acute setting

-Basic computer proficiency (Microsoft Word, Outlook, and Internet)

Preferred Qualifications:

- Undergraduate degree or equivalent experience

-Experience working in utilization management

-Experience working with Medicaid and/or Medicare

-Experience working with Milliman and/or InterQual

-Case Management experience

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.

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.

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.