UnitedHealth Group

RN MSK Preservice Review Nurse Remote

UnitedHealth Group • $60K — $108K *
US-AnywhereRemote in Minnetonka, MN
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Associates or Bachelor's degree in Nursing
  • Current, unrestricted Nursing License or certification
  • Minimum 3 years of experience, with at least 1 year in Musculoskeletal or Pre-Authorization roles
  • Familiarity with clinical criteria (e.g., CMS, InterQual)
  • Proficient in computer applications
  • Availability to work occasional Saturdays if needed

Responsibilities

  • Review Musculoskeletal care requests for medical necessity
  • Evaluate documentation for medical necessity support
  • Determine appropriateness of inpatient and outpatient services based on guidelines
  • Maintain communication with all stakeholders in case management
  • Follow documentation and performance guidelines diligently
  • Assess customer needs and identify solutions for nonstandard requests
  • Operate with minimal guidance, seeking help only for complex issues

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase option
  • 401k contribution
  • Flexible career development opportunities
Full Job Description


Primary Responsibilities:

  • Review of Musculoskeletal (MSK)care requests to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria
  • Review documentation submitted to support the medical necessity of the request
  • Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
  • Maintains contact with all parties involved in case necessary for case management for the client
  • Adheres to all documentation and performance guidelines
  • Assesses and interprets customer needs and requirements
  • Identifies solutions to nonstandard requests and problems
  • Works with minimal guidance; seeks guidance on only the most complex tasks


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:

  • Associates, Bachelors or equivalent in Nursing
  • Current and active unrestricted Nursing License or certification
  • 3+ years of experience, with 1+ years of Musculoskeletal, or Pre-Authorization related experience
  • Knowledge of the clinical criteria (e.g. CMS, InterQual, etc.)
  • Proficiency in operating computer applications
  • Willing to work an occasional Saturday if requested by the business


Preferred Qualifications:

  • Medicare Pre-Authorization experience
  • Managed Care experience
  • Proven excellent interpersonal skills
  • Proven excellent verbal and written communications skills


*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ

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