Radiation Oncology Preservice Review Nurse RN
2 days ago
At UnitedHealth Group, we're committed to helping people live healthier lives and making the health system work better for everyone. As a Radiation Oncology Preservice Review Nurse RN, you'll play a critical role in ensuring that patients receive the best possible care.
Key Responsibilities:- Determine the appropriateness of outpatient services based on medical guidelines and benefit determination
- Validate cases/requests for services require additional research
- Identify and utilize appropriate resources to conduct non-clinical research
- Prioritize cases based on appropriate criteria
- Ensure compliance with applicable federal/state requirements and mandates
- Review/interpret clinical/medical records submitted from providers
- Identify missing information from clinical/medical documentation, and request additional medical or clinical documentation as needed
- Review and validate diagnostic/procedure/service codes to ensure their relevance and accuracy
- Apply understanding of medical terminology and disease processes to interpret medical/clinical records
- Make determinations per relevant protocols, as appropriate
- 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
- 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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