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.   If you are located in Kingston, New York, you will have the flexibility to telecommute* as you take on some tough challenges.   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 Candidates must reside within a 60 miles radius from our Kingston, New York, office. Required Qualifications: Current, unrestricted RN license in the state of residence 3+ years recent hands on clinical experience in an inpatient, physician practice and / or acute setting Proficient with Microsoft Word to create, edit, save and send documents.  Ability to navigate a Windows environment, Microsoft Outlook and conduct Internet searches Preferred Qualifications: Undergraduate degree (BSN) or equivalent experience Previous managed care experience Utilization management, prior authorization or case management experience Working knowledge of Milliman and / or InterQual Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)   *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.   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:  Registered Nurse, RN, Nurse, Predeterminations, Prior Authorization, Concurrent Review, Managed Care, Utilization, Utilization Management, Prior Auths, Care Management, Milliman, Interqual, UHC, UnitedHealthcare, UHG, Kingston, Albany, NY, New York

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.