Prior Authorization RN - Air Ambulance and Out of Country Team - Telecommute - 2020837
UnitedHealth Group
2021-11-05T01:16:45Z
St. Louis
Missouri
United States
Healthcare - Nursing
(No Timezone Provided)
For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) This Prior Authorization RN role is with the Air Ambulance and Out of Country Team , which is unique in Clinical Advocacy and Support. This team crosses all lines of business, processes, and platforms. It is a high profile and fast paced team with short regulatory turn-around times. The team interacts with members, air ambulance providers, and facilities around the world. The team reviews and monitors international inpatient admissions, international outpatient requests, and facility to facility transfer requests involving air ambulance, both international and within the US. The Air Ambulance and Out of Country team is the only Clinical Advocacy and Support team which has required on-call duties and is available 24/7. Air Ambulance and Out of Country nurses rotate on call duties to provide coverage. The hours for this position are Monday through Friday: 8:00am to 5:00pm plus ON CALL duties. On-call rotates – one week per month and at times, 2 weeks per month due to calendar and/or PTO. This is a high profile fast paced team with short regulatory requirements and contact with multiple departments, members, vendors and work closely with medical directors. Primary Responsibilities:
Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information Function as a member of a self-directed team to meet specific individual and team performance metrics Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information Acts as a resource for others with less experience Work independently and collaborating with Medical Directors and non-clinical partners Adapt to a highly changing environment and a heavy case load Required Qualifications:
A current, unrestricted RN license in the state of residency 3+ years total RN experience Experience in an inpatient/acute care setting Demonstrate a proficiency in computer skills – Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel and Outlook Exemplary clinical documentation skills; critical thinking skills Dedicated, distraction-free space in home for home office Access to install secure high speed internet (Cable, DSL, Broadband) Preferred Qualifications:
IQ experience highly preferred Utilization management/review Air ambulance review experience Flight nurse experience Expatriate experience NLC (Nurse License Compact) RN license Bachelor’s Degree Background involving utilization review for an insurance company or experience in case management Familiarity with Milliman Care Guidelines Demonstrated written proficiency for Spanish UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
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.
Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
Prior Authorization RN - Air Ambulance and Out of Country Team - Telecommute - 2020837
For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) This Prior Authorization RN role is with the Air Ambulance and Out of Country Team , which is unique in Clinical Advocacy and Support. This team crosses all lines of business, processes, and platforms. It is a high profile and fast paced team with short regulatory turn-around times. The team interacts with members, air ambulance providers, and facilities around the world. The team reviews and monitors international inpatient admissions, international outpatient requests, and facility to facility transfer requests involving air ambulance, both international and within the US. The Air Ambulance and Out of Country team is the only Clinical Advocacy and Support team which has required on-call duties and is available 24/7. Air Ambulance and Out of Country nurses rotate on call duties to provide coverage. The hours for this position are Monday through Friday: 8:00am to 5:00pm plus ON CALL duties. On-call rotates – one week per month and at times, 2 weeks per month due to calendar and/or PTO. This is a high profile fast paced team with short regulatory requirements and contact with multiple departments, members, vendors and work closely with medical directors. Primary Responsibilities:
Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information Function as a member of a self-directed team to meet specific individual and team performance metrics Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information Acts as a resource for others with less experience Work independently and collaborating with Medical Directors and non-clinical partners Adapt to a highly changing environment and a heavy case load Required Qualifications:
A current, unrestricted RN license in the state of residency 3+ years total RN experience Experience in an inpatient/acute care setting Demonstrate a proficiency in computer skills – Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel and Outlook Exemplary clinical documentation skills; critical thinking skills Dedicated, distraction-free space in home for home office Access to install secure high speed internet (Cable, DSL, Broadband) Preferred Qualifications:
IQ experience highly preferred Utilization management/review Air ambulance review experience Flight nurse experience Expatriate experience NLC (Nurse License Compact) RN license Bachelor’s Degree Background involving utilization review for an insurance company or experience in case management Familiarity with Milliman Care Guidelines Demonstrated written proficiency for Spanish UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
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.
Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.