Medicaid Prior Authorization RN job in Atlanta



Found in: S US – 6 hours ago

Atlanta, United States UnitedHealth Group Full time

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to 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 role will be performing outpatient clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration for outpatient procedures and services. This employee will be required to work 8.5 hours (8 hours + 30 minute lunch) within the time frame of 8:00am and 6:00pm Central Standard Time zone.  Rotating Saturdays are required as well (approximately every 6 to 12 weeks).  If you are licensed in/reside in Hawaii, you will have the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:

  • 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 Compact State RN license in the state of Hawaii
  • 3+ years as a Registered Nurse (RN)
  • 3+ years of RN clinical experience in a hospital inpatient/acute care setting
  • Demonstrate a proficiency in computer skills – Windows, Instant Messaging, Microsoft Suite including Word, Excel and Outlook
  • Exemplary clinical documentation skills; critical thinking skills
  • Excellent communication skills both verbal and written
  • Must dedicated, distraction-free, space for home office
  • Access to install secure high-speed internet (minimum speed 1.5 download mps & 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement)

Preferred Qualifications:

  • Bachelor’s Degree
  • Broad range of nursing experience – med surg, ICU, ER
  • Background involving utilization review for an insurance company or experience in case management
  • Genetics experience
  • Experienced in Medicare, Medicaid and CMS guidelines and regulations
  • Familiarity with Milliman Care Guidelines or InterQual
  • Experience in medical necessity review, medical record review, medical record audits
  • Experienced in collaborating with physicians and other healthcare professionals
  • Knowledge of ICD 10 and CPT coding
  • The ability to work seamlessly and independently in multiple computer platforms
  • The ability to be flexible and willing to adapt to an ever-changing environment 

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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)Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $53,300 to $95,100. The salary range for Connecticut/Nevada residents is $58,800 to $104,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter PolicyDiversity 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. 


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