Are you ready for your next challenge? Discover it here at UnitedHealthcare and help us reinvent the health system. This can be your opportunity to take on a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. You will discuss cases with treating physicians and other healthcare professionals to ensure our members receive the proper health services. This is an exciting opportunity at a truly inspired organization. Join us. This can be the start of **your life's best work.(sm)** What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within 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. **Primary Responsibilities:** + Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information + Function as a member of a self-directed team to meet specific individual and team performance metrics + Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations + Telephonic discussion with health care providers and / or members to explain benefit coverage determinations and to obtain additional clinical information + Acts as a resource for others with less experience + Work independently and collaborating with Medical Directors and non-clinical partners + Adapt to a highly changing environment and a heavy case load The positions are based on a standard work schedule that is Monday thru Friday that may require flex weekends, rotating weekends, a flexible schedule or varying start times. The positions are telecommute and some may require the candidate to reside within a specific state. They are hourly, non-exempt and overtime eligible. Thank you for considering this job posting. The posting is for applicants to be considered for Clinical Coverage Review positions as they become available. The number of positions available can be variable and there can be a large number of qualified candidates. Thank you again for your interest in this position and for being patient with the recruitment process. **Required Qualifications:** + A current unrestricted RN license in the state of residency + Minimum of 3 years total RN experience + Minimum of 3 years ofdirect patient ACUTE CARE experience in a hospital setting + Demonstrate a proficiency in computer skills - Windows, Instant Messaging, Microsoft Suite including Word, Excel and Outlook + Exemplary clinical documentation skills; critical thinking skills + Must have a quiet secure designated work space and access to install secure high speed internet (minimum speed 5 download mps & 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement) + Self-starter with the ability to handle a fast-paced production environment and multiple review types + Able to maintain a distraction free work environment **Preferred Qualifications:** + NLC (Nurse License Compact) RN license or have an RN license in an eNLC state and can apply + Bachelor's Degree + Background involving utilization review for an insurance company or experience in case management + Familiarity with Milliman Care Guidelines or Interqual + Excellent communication skills both verbal and written + The ability to work seamlessly and independently in multiple computer platforms + Be able to demonstrate a working knowledge and acumen of Microsoft Office products + The ability to be flexible and willing to adapt to an ever changing environment + Medicaid or Government Program experience for certain government positions **Careers with UnitedHealthcare.** Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. UnitedHealthcare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. UnitedHealthcare, incredible ideas in one incredible company and a singular opportunity to do **your life's best work.(sm)** *All Telecommuters will be required to adhere to UnitedHealth Group s Telecommuter Policy. _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._ Job Keywords: UnitedHealthcare, UHC, Telecommute, Remote, Virtual, Preservice Review, Medical Claims Review, MCR, CCR, U/R, U/M, utilization review, utilization management, case management, Milliman, RN, Nurse, Interqual, clinical, documentation
Associated topics: asn, care unit, hospice, intensive, intensive care, mhb, nurse, psychiatric, registered nurse, staff nurse
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.