Specialty Biologic Clinical Review RN - Remote

PowerToFly; Remote; GBP 52,000 - 95,000; Full time

Job summary

A healthcare organization is seeking a Specialty Biologics Clinical Reviewer to manage high-risk patient populations and streamline access to therapy. In this role, you will facilitate communication between care teams and patients, ensuring high-quality support and oversight of intake functions. Candidates must have an active RN license and proficiency in Microsoft Suite, with preference for those holding a BSN and experience in specialty medication management. This position allows for remote work within the U.S.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401(k) contributions

Qualifications

• 2+ years of customer service or healthcare sales experience.
• 2+ years experience in Specialty Biologic Clinical review.
• Experience with prior authorizations approval process.

Responsibilities

• Manage patient population to streamline access to therapy.
• Monitor and lead the intake department.
• Facilitates communication between the care team and patients.
• Complete clinical reviews to ensure appropriate therapy.

Skills

Active unrestricted RN license

Proficient in Microsoft Suite

Customer service

Education

Bachelor of Nursing (BSN)

Job description

About the Role

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Specialty Biologics Clinical Reviewer is responsible for managing high‑risk patient population(s) to streamline patient access to therapy and facilitate communication between FlexCare, the referring provider’s office, and the patient. They are also responsible for monitoring and leading the intake department in accordance with the key business initiatives and growth. This position is hands‑on and will be responsible for oversight of all intake functions, as well as communication with internal and external resources.

This is a full‑time position with typical working hours of Monday through Friday, 8:00 a.m. to 5:00 p.m. Hours and work shifts may change in accordance with business needs. Exempt employees must have the ability to be on‑call and available, as business needs required.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform essential functions.

• Serves as the clinical expert on a subset of high‑risk and/or high‑volume specialty medications.
• Serves as a drug–specific liaison and facilitates ongoing communication regarding their active patient’s education as needed.
• Tracks patients from initial notification of referral, through the intake process and throughout their course of treatment to ensure all barriers to care are identified and addressed promptly.
• Completes clinical reviews to ensure the appropriateness of therapy/prescription per company protocol, Medicare, Medicaid, and commercial payers in multiple states.
• Assists the Intake department in reviewing and gathering all supporting documents to ensure prior authorization approval.
• Composes letters of medical necessity (LMNs) and appeals to advocate for patient access to therapy, as supported by provider documentation, clinical trials, and other medically supported resources.
• Collaborates with manufacturer Patient Services teams to ensure all manufacturer resources are being utilized effectively to support the patient prior to and during treatment.
• Communicates frequently with patients to ensure they are receiving optimal service and to address any reported problems with care.
• Serves as an active member of the Quality Assurance program to identify high‑risk/high‑volume QA initiatives.
• Works closely with Intake, Reimbursement, and Sales to identify areas of program improvement.
• Tracks and reports drug/program‑specific KPIs to company leadership on a monthly basis.

Required Qualifications

• Active unrestricted RN license in the state of employment
• Proficient in Microsoft Suite
• Ability to travel in and out of the state up to 25% of the time

Preferred Qualifications

• Bachelors of Nursing (BSN)
• Experience in managing patients on specialty medications
• Experience composing or assisting in medical writing
• 2+ years of customer service or healthcare sales experience
• 2+ years experience Specialty Biologic Clinical review
• Experience with prior authorizations approval process

All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Compensation and Benefits

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $71,200 to $127,200 annually based on full‑time employment. We comply with all minimum wage laws as applicable.

Application Deadline

This posting will be open for a minimum of 2 business days or until a sufficient candidate pool has been collected. The job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone—of every race, gender, sexuality, age, location and income—deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes—an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.