Preservice Review Nurse RN - Remote | WFH

Company Description: You'll support a program dedicated to managing various aspects of Massachusetts' Long Term Services and Supports (LTSS) program.

Position Overview

As a Preservice Review Nurse (RN), you will play a crucial role in performing pre-service and prior authorization clinical coverage reviews for Home Health Services and Day Habilitation. This position involves close collaboration with managers and peers to ensure effective service delivery.

Primary Responsibilities

Conduct pre-service and prior authorization clinical coverage reviews for Home Health Services and Day Habilitation.

Review and interpret clinical and medical records submitted by providers.

Address provider inquiries and encounters promptly and professionally.

Evaluate the appropriateness of community services based on medical guidelines and benefit determination.

Propose solutions for non-standard requests and resolve problems effectively.

Participate in regular meetings to enhance operational efficiency and collaborate with leadership and team members.

Ensure performance meets established quality standards, evidence-based practice guidelines, and departmental benchmarks.

Serve as a knowledgeable resource, providing explanations and information on complex issues.

Represent the LTSS program positively, embodying corporate values of Integrity, Compassion, Relationships, Innovation, and Performance.

Occasional travel within Massachusetts, estimated at 10% of working time.

Why Consider Joining Us

At our organization, we offer a competitive base salary, comprehensive benefits package, performance rewards, and a supportive management team dedicated to your success. Our benefits include:

Paid Time Off and 8 Paid Holidays from your first pay period.

Medical, Dental, Vision, Life & AD&D Insurance, Short-term and Long-term Disability coverage.

401(k) Savings Plan, Employee Stock Purchase Plan.

Education Reimbursement, Employee Discounts, Employee Assistance Program, and more.

Required Qualifications

Associate's Degree (or higher) in Nursing.

Active, unrestricted RN license in Massachusetts.

Minimum of 3 years of clinical and/or Prior Authorization Utilization Management experience.

Dedicated home workspace with secure, high-speed internet access (cable or DSL).

Preferred Qualifications

Residency in Massachusetts.

Familiarity with Massachusetts Medicaid.

Previous experience in Day Habilitation and/or Home Health Services.

Proficiency in Microsoft Office programs (Word, Excel, PowerPoint).

Excellent communication skills, including clear and concise writing for diverse audiences.

Strong time management, organizational, and prioritization abilities, with a capacity to manage multiple tasks independently.

Note: All Telecommuters must adhere to UnitedHealth Group's Telecommuter Policy.

Employment Type: Full-Time