Utilization Management RN — Remote/DC Area

Optum; Washington (District of Columbia); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Sign-on bonus

Remote work option

Comprehensive benefits

Job summary

OptumCare is seeking an HCBS Utilization Management Nurse in the greater Washington, DC area. You will perform pre-service clinical coverage reviews for PDN and PCS, determine medical necessity, and coordinate with interdisciplinary teams.

This role requires coordination with internal partners and external HCBS providers. A DC RN license and 2+ years of utilization management experience are required, with telecommuting options available for eligible candidates.

Qualifications

• Unrestricted RN license in the District of Columbia.
• 2+ years of clinical experience in health care clinical settings.
• 2+ years working in a managed care setting.
• 2+ years of utilization management experience.
• Proficiency with Microsoft Office Suite programs (Word, Excel, Outlook).

Responsibilities

• Intake of provider, care coordinator, and Continuity of Care HCBS authorization requests.
• Review and processing of HCBS authorizations including SMW budget review.
• Assist case management to determine approval and interventions needed.
• Engage with the National Letter Team to complete mailing of member and provider notification of decision.
• Engage / follow-up with Medical Director to provide clinical information for review and application of clinical criteria.
• Work closely with medical director on issues regarding care delivery.
• Engage / follow-up with Care Management for assessment of member care needs.
• Participate in UM meetings and audits.
• Maintain professional conduct and collaboration with HCBS and external providers.

Skills

RN license

Clinical experience

Managed care

Utilization management

MS Office

Tools

Microsoft Office Suite

Job description

OptumCare is seeking an HCBS Utilization Management Nurse in the greater Washington, DC area. You will perform pre-service clinical coverage reviews for PDN and PCS, determine medical necessity, and coordinate with interdisciplinary teams.

This role requires coordination with internal partners and external HCBS providers. A DC RN license and 2+ years of utilization management experience are required, with telecommuting options available for eligible candidates.