Healthcare Review Specialist RN

4 weeks ago

Eden Prairie, Minnesota, United States UnitedHealth Group Full time
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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health equity on a global scale.

Join us to start Caring. Connecting. Growing together.

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

Primary Responsibilities:

  • Review of Musculoskeletal (MSK)care requests to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria
  • Review documentation submitted to support the medical necessity of the request
  • Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
  • Maintains contact with all parties involved in case necessary for case management for the client
  • Adheres to all documentation and performance guidelines
  • Assesses and interprets customer needs and requirements
  • Identifies solutions to nonstandard requests and problems
  • Works with minimal guidance; seeks guidance on only the most complex tasks


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:

  • Undergraduate degree or equivalent experience
  • Current and active unrestricted Nursing License or certification
  • 3+ years of experience, with 1+ years of Musculoskeletal, Case Management, or Pre-Authorization related experience
  • Proven knowledge of the clinical criteria (e.g. CMS, InterQual, etc.)
  • Proficiency in operating computer applications


Preferred Qualifications:

  • Medicare Pre-Authorization experience
  • Managed Care experience
  • Proven excellent interpersonal skills
  • Proven excellent verbal and written communications skills


C 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 local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable.

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, you'll find a far-reaching choice of benefits and incentives.


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.


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.


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.

  • Clinical Claim Review Nurse

    4 weeks ago

    Eden Prairie, Minnesota, United States UnitedHealth Group Full time

    Job SummaryUnitedHealth Group is seeking a Clinical Claim Review Nurse to join our team. As a Clinical Claim Review Nurse, you will be responsible for performing clinical reviews post-service utilizing established guidelines and clinical criteria. You will work in a fast-paced environment with a focus on improving the member and provider experience.Key...

  • Travel Allied Healthcare Professional

    3 weeks ago

    Eden Prairie, Minnesota, United States Host Healthcare Full time

    About the Job:Host Healthcare is seeking an experienced Physical Therapist for a travel allied job in a dynamic healthcare setting. This exciting opportunity offers a chance to work with a responsive team and provide top-notch care to patients in need.Key Details:Shift: Inquire for more informationDuration: 13 weeksPay: $2184.93 per weekAbout Host...

  • Inpatient Care Management Specialist RN

    3 weeks ago

    Eden Prairie, Minnesota, United States UnitedHealth Group Full time

    Key Responsibilities:• Conduct thorough reviews of inpatient cases to ensure adherence to evidence-based criteria.• Collaborate with healthcare professionals to discuss patient plans-of-care and optimize treatment outcomes.• Work closely with Optum Enterprise Clinical Services Medical RN to ensure seamless care coordination.• Develop and implement...

  • Travel Nurse RN Interventional Radiology Specialist

    4 weeks ago

    Eden Prairie, Minnesota, United States Genie Healthcare Full time

    Job Title: Travel Nurse RN Interventional RadiologyGenie Healthcare is seeking a skilled Travel Nurse RN Interventional Radiology professional to provide high-quality patient care in a dynamic environment.Job Summary:We are looking for a highly motivated and experienced Travel Nurse RN Interventional Radiology to work with our clients in a fast-paced...

  • Travel Nurse RN Position in Prarie City, Oregon

    4 weeks ago

    Eden Prairie, Minnesota, United States SkyBridge Healthcare Skilled Nursing Full time

    SkyBridge Healthcare Skilled Nursing is seeking a travel nurse RN for a long-term care position in Prarie City, Oregon.Job DetailsSpecialty: Long Term CareDiscipline: RNDuration: 13 weeksHours per week: 36Shift: 12 hours, nightsThe travel nurse will work in a skilled nursing facility, providing high-quality patient care and collaborating with the healthcare...

  • Travel Nurse RN Long Term Care Specialist

    4 weeks ago

    Eden Prairie, Minnesota, United States LanceSoft Full time

    Job Title: Travel Nurse RN Long Term Care SpecialistLanceSoft is seeking a skilled Travel Nurse RN Long Term Care Specialist to join our team. This is a unique opportunity to work in a dynamic environment and make a meaningful impact in the lives of our patients.Job Requirements:Graduate of an accredited program of nursing educationCurrent Oregon RN...

  • Expense Report Specialist

    4 weeks ago

    Eden Prairie, Minnesota, United States HomeServices of America Inc Full time

    Job Title: Expense Report SpecialistHomeServices of America Inc is seeking a highly detail-oriented and organized Expense Report Specialist to join our Shared Success Center team.About the RoleThe Expense Report Specialist will be responsible for reviewing and processing expense reports to ensure compliance with company policies and procedures.Key...

  • Pharmaceutical Specialist

    3 weeks ago

    Eden Prairie, Minnesota, United States Actalent Full time

    Job Title: Pharmaceutical SpecialistMain Responsibilities:Review and verify prescriptions to ensure accuracy and determine the necessary ingredients and formulas.Compound sterile and non-sterile medications using standard processes and formulas, including weighing, measuring, and mixing ingredients.Lead and direct other pharmacy employees in the preparation,...

  • Occupational Therapist

    4 weeks ago

    Eden Prairie, Minnesota, United States Interim HealthCare of the Twin Cities Full time

    Job Title: Occupational Therapist - Home Care SpecialistJoin Interim HealthCare of the Twin Cities as a skilled Occupational Therapist - Home Care Specialist and make a meaningful difference in the lives of patients in their home environment.About the Role:As an Occupational Therapist - Home Care Specialist, you will work independently to assess and treat...

  • Caregiver Specialist

    4 weeks ago

    Eden Prairie, Minnesota, United States MSP Home Healthcare Inc Full time

    Job SummaryMSP Home Healthcare Inc is seeking a highly motivated and compassionate Caregiver Specialist to join our team. As a Caregiver Specialist, you will play a vital role in supporting clients in their homes and communities, promoting their independence and well-being.Key Responsibilities:Assist clients with daily personal tasks, including bathing and...

  • Pharmaceutical Specialist

    3 weeks ago

    Eden Prairie, Minnesota, United States Actalent Full time

    Job Title: Pharmaceutical SpecialistJob Summary: We are seeking a skilled Pharmaceutical Specialist to join our team at Actalent.Main Responsibilities:* Review prescriptions issued by physicians to ensure accuracy and determine the necessary formulas and ingredients* Compound sterile and non-sterile medications using standard formulas and processes* Direct...

  • Travel Nurse RN Position

    4 weeks ago

    Eden Prairie, Minnesota, United States Genie Healthcare Full time

    Genie Healthcare is seeking a travel nurse RN for a long term care position in Oregon. **Job Details:** * Specialty: Long Term Care * Discipline: RN * Duration: 13 weeks * Hours: 36 hours per week * Shift: 12 hours, days * Employment Type: Travel **Requirements:** * 2-3 years of LTC experience needed **About Genie Healthcare:** Genie Healthcare is one...

  • Document Control Specialist

    4 weeks ago

    Eden Prairie, Minnesota, United States Phillips and Temro Full time

    Job Summary:This role reports to the Engineering Manager and is responsible for ECO processing, maintaining and publishing Engineering process documents. The successful candidate will be the primary reviewer of engineering change requests, change orders, and change notices, and will be responsible for controlled Engineering process document maintenance and...

  • Project Planning Specialist

    3 weeks ago

    Eden Prairie, Minnesota, United States Asterix Communications Full time

    Job Title: Project Planning SpecialistJob Summary:We are seeking a highly skilled Project Planning Specialist to join our team at Asterix Communications. The successful candidate will be responsible for supporting integrated projects planning, scheduling, and progress reporting procedures for our Qatargas projects.Key Responsibilities:Support planning and...

  • Travel Nursing Opportunities with LRS Healthcare

    3 weeks ago

    Eden Prairie, Minnesota, United States Travel Nurse Source Full time

    Are you a dedicated and compassionate registered nurse looking to take your career to the next level? LRS Healthcare is working with Travel Nurse Source to find a qualified Case Manager RN to join their team in Prairie City, Oregon.About the PositionLRS Healthcare is a leading healthcare staffing agency that offers flexible travel RN jobs nationwide with top...

  • Telephonic Case Manager RN Medical Oncology Specialist

    4 weeks ago

    Eden Prairie, Minnesota, United States UnitedHealth Group Full time

    Telephonic Case Manager RN Medical OncologyAt UnitedHealth Group, we are committed to helping people live healthier lives and making the health system work better for everyone. We believe that everyone deserves the opportunity to live their healthiest life, regardless of their background or circumstances.Job SummaryWe are seeking a highly skilled and...

  • Radiologic Imaging Specialist

    3 weeks ago

    Eden Prairie, Minnesota, United States MLee Healthcare Staffing and Recruiting, Inc Full time

    Job Summary:As a Radiologic Imaging Specialist at MLee Healthcare Staffing and Recruiting, Inc, you will be responsible for performing a variety of diagnostic imaging procedures, including X-ray, fluoroscopy, and portable imaging, following established protocols and safety guidelines.Key Responsibilities:* Prepare patients for procedures, explaining the...

  • Accounting Operations Specialist

    3 weeks ago

    Eden Prairie, Minnesota, United States Boulay Full time

    Job SummaryBoulay is seeking a highly skilled and experienced Accounting Operations Specialist to join our team. As a key member of our Accounting Team, you will be responsible for ensuring the accuracy and efficiency of our clients' financial operations.Key Responsibilities:Manage and review financial transactions, including invoicing, bill payments, and...

  • Travel Nurse RN

    4 weeks ago

    Eden Prairie, Minnesota, United States Host Healthcare Full time

    Travel Nursing Opportunity with Host HealthcareHost Healthcare is seeking a skilled Travel Nurse RN to join their team in a Medical-Surgical setting. As a travel nurse with Host Healthcare, you will have the opportunity to work in a variety of settings and locations, while enjoying the benefits of a stable and supportive employer.Job DetailsSpecialty:...

  • Travel Healthcare Professional

    7 days ago

    Eden Prairie, Minnesota, United States Medical Solutions LTC Full time

    Medical Solutions LTC is seeking a highly skilled travel healthcare professional for a Long Term Care Registered Nurse position in Oregon.About the JobThis 13-week contract offers a competitive salary and benefits package, including:A base salary of $120.00 per hour with potential for overtime at the same ratePaid housing, medical, dental, and vision...