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Preservice Review Nurse RN - Remote In Hawaii - Remote Eligible

Evaluate clinical documentation to determine medical necessity and coverage decisions
Honolulu, Hawaii, United States
Senior
$28 – 50 USD / hour
yesterday
UnitedHealth Group

UnitedHealth Group

A diversified health and well-being company offering a broad spectrum of products and services through two distinct platforms: UnitedHealthcare and Optum.

475 Similar Jobs at UnitedHealth Group

Caring. Connecting. Growing Together.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Join us to start Caring. Connecting. Growing together.

Positions in this family require a current, unrestricted nursing license (i.e. RN) in the applicable state, as indicated in the function description and/or job title.

Positions in this function require various nurse licensure and certification based on role and grade level. Licensure includes RN, depending on grade level, with current unrestricted licensure in applicable state.

General Job Profile:

  • Generally work is self-directed and not prescribed
  • Works with less structured, more complex issues
  • Serves as a resource to others

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • 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
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Translates concepts into practice
  • Provides explanations and information to others on difficult issues
  • Coaches, provides feedback, and guides others
  • Acts as a resource for others with less experience

Functional Competencies:

  • CPS_Conduct Non-Clinical Research to Support Determinations
  • CPS_Review Existing Clinical Documentation
  • CPS_Conduct Clinical Research to Support Determinations
  • CPS_Make Final Determinations Based on Clinical and Departmental Guidelines
  • CPS_Achieve and Maintain Established Productivity and Quality Goals
  • CPS_Drive Effective Clinical Decisions Within a Business Environment

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:

  • Current unrestricted RN license in the state of residency
  • 3+ years of RN experience in an acute setting
  • Advanced computer proficiency (Microsoft Word, Outlook, and Internet)
  • Flexible with work hours - hours/days can change as needed for the business
  • Open to required weekend rotation schedule in the future

Preferred Qualifications:

  • 3+ years of experience as an RN in utilization management
  • Compact RN license

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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Preservice Review Nurse RN - Remote In Hawaii - Remote Eligible
Honolulu, Hawaii, United States
$28 – 50 USD / hour
Registered Nurse
About UnitedHealth Group
A diversified health and well-being company offering a broad spectrum of products and services through two distinct platforms: UnitedHealthcare and Optum.