Radiation Oncology Preservice Review Nurse RN

1 week ago

TN United States UnitedHealth Group Full time
Telephonic Oncology Preservice Review Nurse

At UnitedHealth Group, we're committed to helping people live healthier lives and making the health system work better for everyone. As a Telephonic Oncology Preservice Review Nurse, you'll play a critical role in ensuring that patients receive the best possible care.

Key Responsibilities:
  • Determine the medical appropriateness of outpatient services by evaluating medical guidelines and benefit determination.
  • Conduct pre-service clinical coverage reviews of services that require notification, using applicable benefit plan documents, evidence-based medical policy, and nationally recognized clinical guidelines and criteria.
  • Validate that cases/requests for services require additional research and identify relevant information needed to make medical or clinical determinations.
  • Apply understanding of medical terminology and disease processes to interpret medical/clinical records and make determinations per relevant protocols.
  • Review care coordinator assessments and clinical notes, as appropriate.
Requirements:
  • Current, unrestricted RN license in your state of residence.
  • Ability to obtain licensure in other states as needed.
  • 2+ years of Radiation Oncology experience as a Nurse.
  • Computer proficiency, to include solid data entry skills and the ability to navigate a Windows environment.
  • Access to high-speed internet from home (Broadband cable, Fiber, or DSL).
  • Dedicated workspace for home office setup.
  • Ability to work schedule listed.
Preferred Qualifications:
  • OCN Certification.
  • Chemo/Bio Certification.
  • Certified Case Manager (CCM).
  • 7+ years of Radiation Oncology experience.
  • ICD Coding experience or solid knowledge of codes.
  • NCCN experience.
  • Background in preservice review/utilization review/utilization management.

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.

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