Current jobs related to Registered Nurse RN Prior Authorization Specialist - Gonzales - UnitedHealth Group


  • Gonzales, United States Sage Rehabilitation Hospital and Outpatient Services Full time

    At Sage Rehabilitation Hospital and Outpatient Services, we are seeking a skilled Nurse Care Specialist to join our team of dedicated healthcare professionals. As a Registered Nurse, you will play a vital role in delivering exceptional patient care and fostering a supportive environment.As a Nurse Care Specialist, you will be responsible for coordinating all...


  • Gonzales, Texas, United States Nurse First Full time

    Job Title: Travel Nurse RN Operating RoomNurse First is seeking a skilled travel nurse RN to join our team in an Operating Room setting.Job Details:Specialty: Operating RoomDiscipline: Registered Nurse (RN)Duration: 13 weeksShift: 10 hours, daysEmployment Type: TravelNurse First offers a competitive pay package based on 10 hour shifts and 40 hours per week,...


  • Gonzales, Texas, United States ALOIS Healthcare Full time

    Job Title: Travel Nurse RN SpecialistALOIS Healthcare is seeking a travel nurse RN specialist to join their team in Gonzales, Texas.Job Description & RequirementsSpecialty: PACU - Post Anesthesia CareDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hoursEmployment Type: TravelAs a travel nurse RN specialist, you will be responsible for monitoring...


  • Gonzales, Texas, United States Wellspring Nurse Source Full time

    Travel Nurse RN PACU Job OpportunityWellspring Nurse Source is seeking a skilled travel nurse RN to join our team in Gonzales, Texas.Job Requirements:Specialty: PACU - Post Anesthesia CareDiscipline: RNDuration: 13 weeksShift: 12 hours, nightsEmployment Type: TravelOur travel nurse RN will work in a dynamic and supportive environment, providing exceptional...

  • Registered Nurse

    10 hours ago


    Gonzales, United States Gonzales Healthcare Center Full time

    :RN Weekend Supervisor open, 8 hours Sat and Sun:Starting Rate:$32 - $30 / hr. based on experience$34 - $39 / hr. based on experience for Sat-Sun positions:Shift Differential:2pm - 10pm: $1.00/hour10pm - 6am: $1.50/hour:INDNURAsk us about our Level 1 and 2 educational programs. RNs can earn up to an additional $.75 per hour per level with the potential of an...


  • Gonzales, Texas, United States Nurse First Full time

    Job Title: Travel Nurse RNNurse First is seeking a skilled travel nurse RN to join our team in a dynamic Operating Room environment.Job Summary:We are committed to providing our travel nurses with the best experience possible, and we believe that our travel nurses should focus on taking care of their patients while experiencing different places without any...

  • Travel Nurse RN

    2 weeks ago


    Gonzales, United States Wellspring Nurse Source Full time

    Travel PACU - Post Anesthesia Care JobWe are seeking a skilled Travel Nurse RN to join our team in Gonzales, Texas. This 13-week assignment offers a unique opportunity to work in a dynamic PACU environment and provide exceptional patient care.Job DetailsSpecialty: PACU - Post Anesthesia CareDiscipline: RNStart Date: ASAPDuration: 13 weeksShift: 12 hours,...

  • Travel Nurse RN

    2 weeks ago


    Gonzales, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is seeking a skilled travel nurse RN to fill a 13-week position in Gonzales, Texas.Job DetailsSpecialty: PACU - Post Anesthesia CareDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelAs a travel nurse with Wellspring Nurse Source, you'll enjoy a tax-free stipend and competitive pay package...


  • Gonzales, United States Reliable Nurse Staffing Full time

    Job Title: Travel Nurse RNReliable Nurse Staffing is seeking a skilled travel nurse RN to join our team in Gonzales, Texas.Job Details:Specialty: PACU - Post Anesthesia CareDiscipline: RNDuration: 13 weeksHours: 36 hours per weekShift: 12 hoursEmployment Type: TravelWe are looking for a reliable and competent nurse to provide exceptional care to our...


  • Gonzales, Texas, United States Nurse First Full time

    Nurse First is seeking a skilled travel nurse for an Operating Room position in a dynamic healthcare setting.Job DetailsSpecialty: Operating RoomDiscipline: Registered Nurse (RN)Duration: 13 weeksHours: 40 hours per weekShift: 10 hours, daysEmployment Type: TravelNurse First offers a competitive pay package based on 10 hour shifts and 40 hours per week, with...


  • Gonzales, United States Restorixhealth Full time

    At RestorixHealth, our mission is simple...to restore health and improve the quality of life! Our Wound Care Registered Nurses (will train) are the heart and soul behind what we do. Utilizing the Nursing Process, the RN/LPN plans, implements, directs and evaluates patient care to achieve optimal outcomes. The Wound Care Nurse works collaboratively with all...

  • Travel Nurse RN

    7 days ago


    Gonzales, United States Access Health Care Physicians LLC Full time

    PACU Travel Nursing OpportunityAccess Healthcare is seeking a skilled Travel Nurse RN to join our team in Gonzales, Texas. As a Post Anesthesia Care Specialist, you will provide high-quality patient care in a fast-paced PACU environment.Job Details:Specialty: PACU - Post Anesthesia CareDiscipline: RNStart Date: ASAPDuration: 13 weeksHours: 36 hours per...


  • Gonzales, Texas, United States Reliable Nurse Staffing Full time

    Job Title: Travel Nurse RN PACUReliable Nurse Staffing is seeking a travel nurse RN for a PACU - Post Anesthesia Care position in Gonzales, Texas.Job Description & RequirementsSpecialty: PACU - Post Anesthesia CareDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hoursEmployment Type: TravelReliable Nurse Staffing is currently seeking positions in...

  • Travel Nurse RN

    5 days ago


    Gonzales, United States PRIDE Health Full time

    PRIDE Health is seeking a skilled travel nurse to join their team as a Post Anesthesia Care Specialist in Gonzales, Texas.Job DetailsSpecialty: PACU - Post Anesthesia CareDiscipline: RNAssignment Length: 13 weeksTotal Hours Per Week: 40The ideal candidate will have experience working in a PACU environment and be able to provide high-quality patient care....


  • Gonzales, United States Restorixhealth Full time

    Wound Care Nurse Job DescriptionAt RestorixHealth, our mission is to restore health and improve the quality of life for our patients. As a Wound Care Nurse, you will play a vital role in achieving this mission by providing high-quality patient care and working collaboratively with our multidisciplinary team.Key Responsibilities:Provide patient care based on...


  • Gonzales, United States Trinity Healthcare LLC Full time

    Job Title: Weekend RN SupervisorWe are seeking an experienced Registered Nurse to join our team at Trinity Healthcare LLC.About the RoleAs a Weekend RN Supervisor, you will be responsible for providing direct nursing care to our residents and supervising the day-to-day nursing activities of an assigned unit. You will work closely with our interdisciplinary...


  • Gonzales, United States Wellspring Nurse Source Full time

    Travel Operating Room Nurse Job in Gonzales, TexasWellspring Nurse Source is seeking a skilled travel nurse to join our team in Gonzales, Texas. As a travel operating room nurse, you will have the opportunity to work in a dynamic and fast-paced environment, providing top-notch care to patients in need.Job Details:Specialty: Operating RoomDiscipline: RNStart...


  • Gonzales, United States Sage Rehabilitation Hospital and Outpatient Services Full time

    Transform Patient Care at Sage Rehabilitation HospitalWe are seeking a compassionate Registered Nurse (RN) to join our team at Sage Rehabilitation Hospital and Outpatient Services. As a skilled nursing professional, you will play a vital role in delivering exceptional patient care and fostering a supportive environment.As a member of our patient care team,...


  • Gonzales, United States Restorixhealth Full time

    Wound Care Nurse Job DescriptionAt RestorixHealth, our mission is to restore health and improve the quality of life. Our Wound Care Registered Nurses are the heart and soul behind what we do.Key Responsibilities:Provide patient care based on scientific principles and nursing theoryRecognize change in the patient's condition and intervene...


  • Gonzales, United States KPG Healthcare Nursing Full time

    Job Title: Post Anesthesia Care Unit Registered NurseKPG Healthcare Nursing is seeking an experienced Post Anesthesia Care Unit Registered Nurse for a travel nursing assignment in Gonzales, Texas.Job Details:Shift: InquireDuration: 13 weeksPay: $1958 / WeekRequirements:BSN or Associate's degreeActive RN License for this state2 or more years of PACU...

Registered Nurse RN Prior Authorization Specialist

1 month ago


Gonzales, United States UnitedHealth Group Full time
Job Summary

WellMed, part of the Optum family of businesses, is seeking a Registered Nurse RN Prior Authorization Specialist to join our team in San Antonio, TX.

As a clinician-led care organization, Optum is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data, and support of a global organization behind you so you can help your patients live healthier lives.

Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim.

We believe you deserve an exceptional career, and will empower you to live your best life at work and at home.

Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country.

Because together, we have the power to make healthcare better for everyone.

This position is responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage guidelines.

The UM Nurse determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally, work is self-directed and not prescribed. The Utilization Management Nurse works under the direct supervision of an RN or MD.

Key Responsibilities:
  • Performs utilization review activities, including pre-certification, concurrent, and retrospective reviews according to guidelines
  • Determines medical necessity of each request by applying appropriate medical criteria to first-level reviews and utilizing approved evidenced-based guidelines/criteria
  • Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary healthcare services
  • Answers Utilization Management directed telephone calls; managing them in a professional and competent manner
  • Refers case to a review physician when the treatment request does not meet necessity per guidelines, or when guidelines are not available
  • Reviews, documents, and communicates all utilization review activities and outcomes, including all calls made and received in regard to case communication and all demographic and service group information
  • Sends appropriate system-generated letters to provider and member
  • May provide guidance and coaching to other utilization review nurses and participate in the orientation of newly hired utilization nurses
  • Identify and refer all potential quality issues to the Clinical Quality Management Department, and suspected fraud and abuse cases to Compliance Department
  • Conducts rate negotiation with non-network providers, utilizing appropriate reimbursement methodologies
  • Documents rate negotiation accurately for proper claims adjudication
  • Identify and refer potential cases to Disease Management and Case Management
  • Performs all other related duties as assigned

This position requires 9AM-6PM CST/Monday-Friday and requires a rotating Saturday schedule with an adjustment day off during the week.

Requirements:
  • Current, unrestricted Texas RN license or compact license
  • 2+ years of experience in managed care OR 5+ years of nursing experience
  • Proficient in PC Software computer skills

We are 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.