Preservice Review Nurse RN - Remote

Optum; Phoenix (AZ); Remote; USD 60,000 - 108,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

Optum is seeking a Preservice Review/Prior Authorization RN to support cross-functional Integrated Care Team across outpatient and inpatient settings. This role offers remote work from anywhere in the U.S.

with duties including initial and ongoing reviews using InterQual criteria, collaboration with Medical Directors and care teams, discharge planning and adherence to procedures. Requirements include an unrestricted RN license in the state of residency, 3+ years of RN experience, proficiency

Qualifications

• Current, unrestricted RN license in state of residency.
• 3+ years of RN experience.
• Proficient computer skills including Microsoft Office Suite (Teams, Word, Excel, and Outlook).
• Demonstrated ability to work independently.
• Demonstrated effective verbal and written communication skills.
• Willing or ability to work weekends.

Responsibilities

• Perform initial and ongoing reviews pertaining to primary role (PA, ICM, DCM, PACM), appropriately applying clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and sending to Medical Directors if review is necessary for determining an adverse determination
• Collaborate with Medical Directors, clinical peers and Health Plan partners on performing appropriate clinical decision making and/or referrals
• Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
• Follow all Standard Operating Procedures in end-to-end management of cases
• Participate in team meetings, education discussions and related activities
• Maintain compliance with Federal, State and accreditation organizations

Skills

RN license

3+ years RN

Microsoft Office

Verbal & written communication

Weekend availability

Education

BSN

MSN

Tools

InterQual

Job description

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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together. The Integrated Care Team leverages a cross-functional approach, supporting the member end to end, with close collaboration and co-management. Generally, work is self-directed and not prescribed; is able to work with less structured and more complex issues. The Preservice Review/Prior Authorization RN will manage the full array of health care services, spanning both outpatient and Inpatient settings and with support from some specialized clinical teams, serves as a resource to others. This new cross-functional collaboration provides an opportunity to deliver the next generation clinical model, integrating services from precertification, inpatient concurrent review, post-acute review, discharge planning, medical and behavioral care management and prevention to improve quality of care and patient outcomes. Candidates for this position would be required to support cross-training to multiple roles: Prior Authorization (PA), Post-Acute Care Management (PACM), Inpatient Care Management (ICM) and Discharge Care Management (DCM) to support fluctuating inventory within the Integrated Care Team. You\'ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Perform initial and ongoing reviews pertaining to primary role (PA, ICM, DCM, PACM), appropriately applying clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and sending to Medical Directors if review is necessary for determining an adverse determination
• Collaborate with Medical Directors, clinical peers and Health Plan partners on performing appropriate clinical decision making and/or referrals
• Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
• Follow all Standard Operating Procedures in end-to-end management of cases
• Participate in team meetings, education discussions and related activities
• Maintain compliance with Federal, State and accreditation organizations

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 state of residency
• 3+ years of RN experience
• Proficient computer skills including Microsoft Office Suite (Teams, Word, Excel, and Outlook)
• Demonstrated ability to work independently
• Demonstrated effective verbal and written communication skills
• Willing or ability to work weekends

Preferred Qualifications

• Bachelor of Science degree in Nursing or a Master of Science degree in Nursing
• Compact RN License
• 2+ years of Case Management experience
• Clinical experience in an inpatient/acute setting, long-term care, acute rehabilitation, or skilled nursing facilities
• Experience performing Discharge Planning
• Experience with InterQual
• Utilization Review experience
• 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. 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). 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 - $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.