Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language and consideration of relevant clinical information Communicate all types of benefit determinations, including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations to providers It feels great to have autonomy and there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decision... more details
At UnitedHealthcare, were 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 to start Caring. Connecting. Growing together.
In this role, youll discuss cases with medical directors and other health care professionals to ensure our members receive the proper health services. Function is responsible for performing pre-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Its an exciting opportunity to bring your skills to a truly inspired organization.
If you are located in NJ you will have the flexibility to to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language and consideration of relevant clinical information
- Communicate all types of benefit determinations, including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations to providers
- It feels great to have autonomy and there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact our members. And at the same time, you'll be challenged by leveraging technologies and resources in a rapidly-changing, production-driven environment
Youll 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 New Jersey
- 3+ years of RNexperience, including experience in an inpatient/acute setting
- 1+ years of experience in utilization review
- Designated home work space and access to install secure high speed internet via cable/DSL
Preferred Qualifications:
- Background involving utilization review for an insurance company or experience in case management
- Familiarity with Milliman Care Guidelines or InterQual
*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy
New Jersey Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves 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. ?
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.
