Registered Nurse Pre-Service Coordinator Remote - Mon-Fri 1pm to 10pm CT

Position overview and responsibilities follow. The Pre-Service Coordinator reviews pre-authorization requests for skilled nursing and rehabilitative services to determine medical necessity for the requested level of care, and coordinates the transition of patients to the appropriate next level of care in accordance with facility policies and procedures.

Primary Responsibilities

• Perform in a hybrid role as either clinical \"gatherer and authorization document creator\" or solely as a clinical and authorization \"reviewer\" for all prospective, concurrent, and retrospective requests within established parameters.
• Review all direct admits to SNF via physician office, ED or home health.
• Execute all expedited prospective reviews, including patient oral and/or written notifications.
• Execute all standard prospective reviews, including patient oral and/or written notifications.
• May have EMR access to mirror Inpatient Care Coordinator partner access.
• Coordinate peer-to-peer reviews with Medical Directors.
• Notify hospitals and SNFs of review outcomes for non-engaged patients.
• Partner with Medical Directors for Pre-Service Coordinator training as needed.
• Complete processes related to pre-service authorizations.
• Educate facilities on the pre-service denial process.
• Participate in the clinical phone queue to ensure customer service level agreements are met.
• Support new delegated contract start-up to ensure experienced staff work with new contracts.

Required Qualifications

• Active, unrestricted RN license in state of residence
• 3+ years of clinical experience
• Experience in oversight and supervision of assistants (CNAs, PTAs, OTAs)
• Experience with physician engagement and crucial conversations
• Ability to work posted shift weekly Monday-Friday 1pm-10pm Central Time
• Willingness to work early/late shifts and longer hours to accommodate peaks in volume as needed

Preferred Qualifications

• 2+ years of Case Management experience
• Experience in acute care, rehab, OR skilled nursing facility environment
• Experience with clinical audits to improve quality standards
• Experience working with geriatric population
• Managed Care experience
• ICD-10 and InterQual experience
• CMS knowledge
• Remote work policy adherence

Compensation and Benefits

Pay range: $34.23/hr - $61.15/hr. Pay is based on several factors including local labor markets, education, work experience, and certifications. In addition to salary, a comprehensive benefits package, incentive/recognition programs, equity stock purchase and 401k contribution are available where eligible.

The hourly pay range is based on full-time employment. This position is remote within the U.S. and may require occasional overtime as business needs dictate.

Application Deadline: Posted for a minimum of 2 business days or until a sufficient candidate pool is collected. Job postings may close early due to volume of applicants.

Telecommuter policy: All remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

Equal Employment Opportunity: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, 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.