POSITION DESCRIPTION Are you ready for your next challenge? Discover it here at UnitedHealthcare and help us reinvent the health system. This can be your opportunity to take on a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. You will discuss cases with treating physicians and other healthcare professionals to ensure our members receive the proper health services. You will be required to maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities in order to help patients through their care plan. This is an exciting opportunity at a truly inspired organization. Join us. This can be the start of YOUR LIFE'S BEST WORK.(SM) What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. EVERY OTHER WEEKEND IS REQUIRED BOTH SATURDAY AND SUNDAY, AND THEN THAT WEEK YOU GET 2 DAYS OFF DURING THE WEEK HOURS WILL BE 8:00AM-5:00PM PST If you are located in West Coast time zone / Pacific time, you will have the flexibility to telecommute* as you take on some tough challenges. PRIMARY RESPONSIBILITIES:

• Perform medical necessity review for services that require prior authorization utilizing specific criteria
• Discuss cases with treating physicians and other healthcare professionals to gather necessary information in order to review the requested services or to give verbal determination on a case
• Request clinical information necessary to review requested services
• Consult with the Medical Director as needed to troubleshoot difficult or complex cases

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:

• Active, unrestricted RN license in your state of residence
• 3+ years of clinical experience (any setting)
• Ability to create, edit, save and send documents utilizing Microsoft Word. Ability to navigate a Windows environment, Microsoft Outlook, and conduct Internet searches
• Ability to be flexible and work in a fast - paced environment
• Able to work every other weekend both Saturday and Sunday

PREFERRED QUALIFICATIONS:

• BSN
• Knowledge of ICD10 and CPT coding
• Knowledge of Milliman Care Guidelines
• Knowledge of Medicare guidelines and regulations
• Detail oriented, self - sufficient and decisive
• Excellent organizational and communication skills
• Previous experience in Prior Authorizations or related function (case management, utilization review, coverage determination, etc.)
• Sound decision making ability

CAREERS WITH OPTUM. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do YOUR LIFE'S BEST WORK.(SM) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy 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. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: RN, registered nurse, nurse, pre-service, prior authorizations, utilization review, utilization management, case management, coverage determination, Medicare, Las Vegas, Nevada, NV, Phoenix, AZ. Arizona, Salt Lake City , UT, Utah, Los Angeles, CA, California, Portland, OR, Oregon, West Coast, PST Job Details

• CONTEST NUMBER 841743
• JOB TITLE Pre - Service Review RN - Telecommute in PST - OPTUM
• JOB FAMILY Nursing
• BUSINESS SEGMENT OptumCare

Job Location Information

• Las Vegas, NV United States North America
• OTHER LOCATIONS Salt Lake City, UT Portland, OR Phoenix, AZ Los Angeles, CA

Additional Job Detail Information

• EMPLOYEE STATUS Regular
• SCHEDULE Full-time
• JOB LEVEL Individual Contributor
• SHIFT Day Job
• TRAVEL No
• TELECOMMUTER POSITION Yes
• OVERTIME STATUS Non-exempt

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.