Preservice Review RN - Remote

Optum; Seattle (WA); Remote; USD 59,000 - 117,000; Full time

Job summary

A leading company in health care is seeking a Utilization Management Nurse to ensure effective delivery of health services. The ideal candidate will possess an RN license and relevant clinical experience while working autonomously in a remote capacity. This position rewards performance and allows for professional growth while aiming to improve community health outcomes.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Qualifications

• 3+ years of Managed Care and/or Clinical experience required.
• Prior-authorization and Utilization Management experience preferred.

Responsibilities

• Conduct utilization management and Prior Authorization Review.
• Determine medical appropriateness of level of care based on guidelines.
• Work independently on less structured, complex issues.

Skills

Managed Care

Clinical experience

Basic computer skills

Education

Unrestricted RN License

Tools

MS Outlook

MS Word

MS Excel

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 to start Caring. Connecting. Growing together.

Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You'll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact?

• Although this position is remote, applicants must be able to work in Pacific Time Zone***
• Weekends are required as part of your weekly schedule. You may work a 5-8 schedule, any 3 days during the week and Sat/Sun or you may work a 4-10 schedule, any 2 days during the week and Sat/Sun.***
  
  

If you are able to work in Pacific Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities

• Positions in this function require unrestricted RN licensure in the state you reside in
• Function is responsible for utilization management which includes Prior Authorization Review of skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospital
• Determines medical appropriateness of level of care following evaluation of medical guidelines and benefit determination
• Generally, work is self-directed and not prescribed
• Works with less structured, more complex issues
• Identify solutions to non-standard requests and problems
• Translate concepts into practice
• Act as a resource for others; provide explanations and information on difficult issues
  
  

It feels great to have autonomy, and there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact our members. And at the same time, you'll be challenged by leveraging technologies and resources in a rapidly changing, production-driven environment.

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 Qualification

• Unrestricted RN License in the state you reside in
• 3+ years of Managed Care and/or Clinical experience
• Proven basic computer skills with MS Outlook, Word and Excel
  
  

Preferred Qualifications

• Prior-authorization experience
• Multi-Specialty experience
• Utilization Management experience
• Experience in a skilled nursing facility or inpatient rehabilitation facility
• Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance
• Knowledge of Milliman Criteria
• Knowledge of Medicare Criteria
• Located in PST or MST time zone
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.