Prior Authorization RN - Must be licensed\/reside in Tennessee

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

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.

This role will be performing outpatient clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information for DME (durable medical equipment).

This employee can choose hours within the time frame of 8:00am and 6:00pm in their time zone. Rotating Saturdays are required as well (approximately every 6 to 12 weeks). If you live in the state of Tennessee, you'll enjoy the flexibility to telecommute* 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 Tennessee
  • 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)
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:
  • NLC (Nurse License Compact) RN license or have an RN license in an eNLC state and can apply
  • 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
  • Experience with DME (durable medical equipment)
  • 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


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 the health system 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.

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