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Prior Authorization RN - Telecommute - Weekends Required

UnitedHealth Group

Hartford, CT
Job Code:
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Job Details

736249 Prior Authorization RN Telecommute Weekends Required

Prior Authorization RN - Telecommute - Weekends Required (736249)

Position Description

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)


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 is a Telecommute, work from home position. The hours for this position are 8:00am to 5:00pm EST, Wednesday - Sunday (Monday & Tuesday off, working weekends)***


Primary Responsibilities:

  • Perform medical necessity review for services that require prior authorization utilizing specific criteria
  • Discuss cases with treating physicians and other healthcare professionals to gather necessary information in order to review the requested services or to give verbal determination on a case
  • Request clinical information necessary to review requested services
  • Consult with the Medical Director as needed to troubleshoot difficult or complex cases

Required Qualifications:

  • Active, unrestricted RN license in your state of residence
  • 3+ years of experience as a Registered Nurse in any setting
  • Ability to create, edit, save and send documents utilizing Microsoft Word.  Ability to navigate a Windows environment, Microsoft Outlook, and conduct Internet searches
  • Dedicated, distraction-free work space for home office and access to high speed internet (DSL or cable)
  • Must be able to work required hours -8:00am to 5:00pm EST, Wednesday - Sunday (includes all weekends)
  • Travel required to Connecticut - up to 25%

Preferred Qualifications:

  • BSN
  • Previous experience in Prior Authorizations or related function (case management, utilization review, coverage determination, etc.)
  • Knowledge of ICD10 and CPT coding
  • Knowledge of Milliman Care Guidelines
  • Knowledge of Medicare guidelines and regulations
  • Knowledge of CMS guidelines 
  • Detail oriented, self - sufficient and decisive
  • Excellent organizational and communication skills
  • Sound decision making ability
  • Ability to be flexible and work in a fast - paced environment

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)



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.



Job Keywords: RN, registered nurse, nurse, preservice, prior authorizations, utilization review, utilization management, case management, coverage determination, Medicare, Telecommute, telecommuter

Job Details

  • Contest Number736249
  • Job TitlePrior Authorization RN - Telecommute - Weekends Required
  • Job FamilyNursing
  • Business SegmentOptum Operations

Job Location Information

  • Hartford, CT
    United States
    North America
  • Other LocationsFarmington, CT
    New Haven, CT
    Boston, MA
    Springfield, MA
    Albany, NY

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusNon-exempt

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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