Medication Oncology RN - Remote

Optum; Downers Grove (IL); Remote; USD 40,000 - 72,000; Full time

Job summary

Optum is seeking Telephonic Oncology Preservice Review Nurses for full-time remote work. The role entails pre-service clinical coverage review using guidelines, benefit plans, and medical policy to determine medical necessity for outpatient services.

You'll evaluate cases, conduct non-clinical research, and ensure compliance with state and federal mandates. The position operates Tue-Sat 8-5 in the candidate's time zone and is fully telecommute across the U.S.

Qualifications

• Current, unrestricted RN license in your state of residence.
• Ability to obtain licensure in other states as needed.
• 3+ years of radiation oncology experience as a Nurse.
• Computer proficiency, to include data entry in a Windows environment.
• Access to high-speed internet from home.
• Dedicated workspace for home office setup.

Responsibilities

• Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial).
• Validate that cases/requests for services require additional research.
• Identify and utilize appropriate resources to conduct non-clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates).
• Prioritize cases based on appropriate criteria (e.g., date of service, urgent, expedited).
• Ensure compliance with applicable federal/state requirements and mandates (e.g., turnaround times, medical necessity).
• Review/interpret clinical/medical records submitted from provider (e.g., office records, test results, prior operative reports).
• Identify missing information from clinical/medical documentation, and request additional documentation as needed.
• Review and validate diagnostic/procedure/service codes for relevance and accuracy (e.g., PNL list, LCDs, NCDs).
• Identify and validate usage of non-standard codes, as necessary.
• Apply understanding of medical terminology and disease processes to interpret records.
• Make determinations per relevant protocols (e.g., approval, denial, further research).
• Review care coordinator assessments and clinical notes, as appropriate.
• Identify relevant information needed to make medical or clinical determinations.
• Identify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG).

Skills

Radiation oncology experience

Data entry

Remote work readiness

Education

Registered Nurse (RN) license

Tools

Windows OS

Home broadband internet

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Medication Oncology RN - Remote (2389344)

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.

We’re making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that’s driving the health care industry forward. As a Telephonic Oncology Preservice Review Nurse you will be performing pre-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Determines medical appropriateness of outpatient services following evaluation of medical guidelines and benefit determination.

This position is fully telecommute and scheduled for Tuesday through Saturday 8-5PM in your time zone with no evenings or on call

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

Primary Responsibilities:

• Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial)
• Validate that cases/requests for services require additional research
• Identify and utilize appropriate resources to conduct non-clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources)
• Prioritize cases based on appropriate criteria (e.g., date of service, urgent, expedited)
• Ensure compliance with applicable federal/state requirements and mandates (e.g., turnaround times, medical necessity)
• Review/interpret clinical/medical records submitted from provider (e.g., office records, test results, prior operative reports)
• Identify missing information from clinical/medical documentation, and request additional medical or clinical documentation as needed (e.g., LOI process, phone/fax)
• Review and validate diagnostic/procedure/service codes to ensure their relevance and accuracy, as applicable (e.g., PNL list, EPAL list, state grid, LCDs, NCDs)
• Identify and validate usage of non-standard codes, as necessary (e.g., generic codes)
• Apply understanding of medical terminology and disease processes to interpret medical/clinical records
• Make determinations per relevant protocols, as appropriate (e.g., approval, denial process, conduct further clinical or non-clinical research)
• Review care coordinator assessments and clinical notes, as appropriate
• Identify relevant information needed to make medical or clinical determinations
• Identify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG, medical

This position will require active and unrestricted Nursing licensure in multiple US States. Selected candidate must be willing and able to obtain and maintain multiple state licensure (Application fees and filing costs paid for by UHG).

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:

• Current, unrestricted RN license in your state of residence
• Ability to obtain licensure in other states as needed
• 3+ years of radiation oncology experience as a Nurse
• Computer proficiency, to include solid data entry skills and the ability to navigate a Windows environment
• Access to high-speed internet from home (Broadband cable, Fiber or DSL)
• Dedicated workspace for home office set up
• Willing and able to work Tuesday through Saturday 8-5PM in your time zone

Preferred Qualifications:

• OCN certification
• ICD Coding experience or solid knowledge of codes
• NCCN experience
• Background in preservice review/utilization review/utilization management

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Application Deadline:

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

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.