Radiation Oncology Preservice Review Nurse RN Position

3 weeks ago

Houston, Texas, United States UnitedHealth Group Full time

At UnitedHealth Group, we are committed to helping people live healthier lives and making the health system work better for everyone.

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.

As a Telephonic Oncology Preservice Review Nurse, you will be 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.

You will determine medical appropriateness of outpatient services following evaluation of medical guidelines and benefit determination.

This position requires active and unrestricted Nursing licensure in multiple US States. You must be willing and able to obtain and maintain multiple state licensure.

Key Responsibilities:

  • Determine that the case is assigned to the appropriate team for review
  • Validate that 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 provider
  • 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

This position will require you to work at home with a full-time schedule and some flexibility with a combination of day and evening hours. You will be required to work some evenings, holidays and weekend hours.

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

Benefits:

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution

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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