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UnitedHealth Group Pre-Service RN - San Juan, PR in San Juan, Puerto Rico

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Primary Responsibilities:

  • Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information

  • 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

The positions are based on a standard work schedule that is Monday thru Friday that may require flex weekends, rotating weekends, a flexible schedule or varying start times. Positions are hourly, non-exempt and overtime eligible.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Active, unrestricted RN license

  • 1+ years of clinical experience as an RN

  • Demonstrate a proficiency in computer skills - Windows, Instant Messaging, Microsoft Suite including Word, Excel and Outlook

  • Proven exemplary clinical documentation skills; critical thinking skills

  • Demonstrated self-starter with the ability to handle a fast-paced production environment and multiple review types

  • Available to work (40 hours/week) Monday-Friday and flexible to work any of our 8 hour shift schedules during our normal business hours of 8:00am to 8:00pm

  • Bilingual proficiency ( Both English and Spanish)

  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

  • Bachelor's Degree

  • Prior authorization / pre-service review experience

  • Background involving utilization review for an insurance company or experience in case management

  • Excellent communication skills both verbal and written

  • Ability to work seamlessly and independently in multiple computer platforms

  • Able to demonstrate a working knowledge and acumen of Microsoft Office products

  • Ability to be flexible and willing to adapt to an ever-changing environment

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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: Utilization Management, utilization review, Pre-service Nurse, Clinical, San Juan, PR