Remote RN Clinical Policy Strategist

Optum; United States; Remote; USD 92,000 - 164,000; Full time

Job summary

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.

This role centers on developing clinical utilization management guidelines, COE network criteria, and leading expert panels, with remote work across the United States.

Qualifications

• Bachelor’s degree in nursing is required.
• Active, unrestricted RN license required.
• 3+ years of experience with scientific/medical literature search and analysis.
• 3+ years of clinical writing such as medical policies or guidelines.
• Experience delivering presentations to professional/executive audiences.
• Familiarity with healthcare quality review principles.
• Proficient in Word, PowerPoint, and Excel; ability to build collaborative relationships.

Responsibilities

• Research and development of product-specific clinical utilization management guidelines including annual literature reviews.
• Develop selection criteria for products with COE networks and conduct annual literature reviews.
• Plan and run annual expert panels consisting of external physician leaders.
• Contribute to network qualification decisions and quality outcome reviews.
• Conduct quality of care investigations for adverse outcomes in Optum products.
• Develop medical billing code sets for claims-based analyses and provide clinical support.
• Support market launch of new Optum products clinically.
• Assist CSI survey coordinators during network qualification processes.

Skills

Scientific/medical literature search

Clinical writing

Public speaking

Healthcare quality review

Education

Bachelor’s degree in nursing

RN license

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.

This role centers on developing clinical utilization management guidelines, COE network criteria, and leading expert panels, with remote work across the United States.