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Preservice Review Nurse - Kingston, NY

UnitedHealth Group

Kingston, NY
Job Code:
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Job Details

Preservice Review Nurse - Kingston, NY(Job Number:727361)

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.  


Candidates must reside within a 60 miles radius from our Kingston, NY office to be considered for this role.  Train in the office and then work from home.


Primary Responsibilities:  

  • Responsible for performing pre-service clinical coverage review of services (predetermination reviews), using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria
  • Responsible for managing clinical Out of Network referral requests
  • Obtain additional clinical information from treating physicians and other healthcare professionals as needed
  • Gather clinical information to assess and expedite care needs
  • Consult with the Medical Director as needed to troubleshoot difficult or complex cases

Job Clin Coverage Rvw/Prior Author
Primary Location US-NY-Kingston
Other Location 
Organization E&I Natl Accts Empire
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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