Preservice Review Nurse RN

Company: UnitedHealth Group
Location: Dallas
Posted on: November 18, 2023

Job Description:

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing -your life's best work.
Positions in this function requires a North Carolina RN. This role works under the direct supervision of the NC Health Plan UM Manager. Function is responsible for performing pre-service clinical coverage review of Private Duty Nursing (PDN) and Personal Care services (PCS), Non-Emergency Medical Transportation (NEMT), and Healthy Opportunities Program (HOP) that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
You'll enjoy the flexibility to telecommute* from anywhere in North Carolina as you take on some tough challenges. -
Schedule: Monday through Friday 8:00 am to 5:00 pm Eastern Standard Time
Primary Responsibilities:

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• Intake of provider, care coordinator, and Continuity of Care HCBS (home and community-based service) assisted technology and environmental modifications authorization requests -
  
• Review and processing of all HCBS service authorization requests
  
• Engage with providers and initiation/follow-up on requests for information
  
• Engage -with the National Letters Team to complete mailing of member and provider notification of decision
  
• Consistent application of criteria for review and approval of provider authorization requests
  
• Engage -/ follow-up with Medical Director to provide clinical information needed for review and application of clinical criteria
  
• Engage -/ follow-up with Care Coordinators for assessment of member care needs
  
• Patient advocate, and have tenacity for finding solutions
  
• Extensive knowledge of the continuum of care
  
• Conduct themselves in a professional manner at all times
  
• Performs other duties as assigned
  
  What are the reasons to consider working for UnitedHealth Group? - - Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
  
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  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
    
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
    
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
    
  • 401(k) Savings Plan, Employee Stock Purchase Plan
    
  • Education Reimbursement
    
  • Employee Discounts
    
  • Employee Assistance Program
    
  • Employee Referral Bonus Program
    
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
    
  • More information can be downloaded at: -
    
    You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:
    
    
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    • Associate's in Nursing or higher
      
    • Unrestricted RN license in the state of North Carolina
      
    • 2+ years of clinical experience in health care clinical settings
      
    • Intermediate level of proficiency with Microsoft Word (ability to create, copy, edit, send and save documents), Microsoft Excel (create, edit, save documents) and Microsoft Outlook (email and calendar management)
      
    • Must live in a location that can receive a UnitedHealth Group approved high - speed internet connection or leverage an existing high - speed internet service
      
    • Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
      
      Preferred Qualifications:
      
      
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      • 2+ years of -experience working in a managed care setting
        
      • Experience in a work from home environment
        
      • Direct experience working with HCBS authorizations and communicating with HCBS providers
        
      • Broad knowledge of the North Carolina Medicaid -
        
      • Experience working within the health care Industry and with health care insurance
        
      • Experience working in a hospital, physician's office or medical clinic setting
        
      • Knowledge of ICD-10 and CPT codes
        
      • Experience working in electronic health systems
        
      • Experience working independently, managing multiple and often competing demands
        
      • Experience working with multi-disciplinary clinical teams
        
      • Experience working with diverse populations - -
        
        Soft Skills:
        
        
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        • Ability to work independently and as a team, and maintain good judgment and accountability -
          
        • Demonstrated ability to work well with health care providers -
          
        • Strong organizational and time management skills -
          
        • Ability to multi-task and prioritize tasks to meet all deadlines -
          
        • Ability to work well under pressure in a fast-paced environment -
          
        • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others
          
          *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. -
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          At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. -
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          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. -
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          #RPO, #GREEN

Keywords: UnitedHealth Group, Dallas , Preservice Review Nurse RN, Healthcare , Dallas, Texas