Remote Financial Clearance Specialist RN – MN or WI

Optum

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Requisition Number: 2226771
Job Category: Nursing
Primary Location: Minneapolis, MN
(Remote considered)

$1,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

You’ll enjoy the flexibility to telecommute* from anywhere within MN or WI as you take on some tough challenges.

Principle Responsibilities

  • Identify requirements to obtain prior authorization denials for Oncology services and other medical specialties as needed
  • Prioritize work per Financial Clearance Service Level Agreements (SLA) and payer deadlines to ensure all patients are cleared per standards in system policies
  • Identify prior authorization requirements for service(s) by using tools, electronic resources (i.e. electronic queries, payer websites) and/or phone/fax
  • Complete daily assignments per leadership direction
  • Assess clinical data from medical records to obtain authorization for scheduled services
  • Abstract and submit clinical data from medical records to insurance payers Utilize clinical screening criteria and reviews insurance payer medical policies to ensure patients meet medical necessity for scheduled services
  • Assure the medical record has the proper physician clinical documentation to support medical necessity for the ordered service
  • Monitor for continued authorization, communicates results and opportunities to nurses, physicians, finance, case managers, and payers
  • Complete work effectively and efficiently maintaining quality and production standards Maintains knowledge of and complies with regulatory requirements, organizational standards, and policies, procedures, and workflows related to areas of responsibility
  • Evaluate potential denials or payment issues and initiates communication with physician or clinician regarding next steps
  • Prepare and facilitates appeals for denied claims, as appropriate
  • Escalate peer to peer requests to the ordering physician, and provide appropriate insight to the provider regarding clinical documentation to support medical necessity for the ordered service
  • Summarize denial trends and report to leadership
  • Complete work effectively and efficiently maintaining quality and production standards
  • Training/mentoring and daily workflow coaching to less experienced team members on all aspects of the prior authorization process
  • Other duties as assigned

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:

  • Bachelor’s Degree in Nursing (or higher)
  • Active Licensed Registered Nurse in the state of Minnesota and/or Wisconsin
  • 3+ years of Managed Care and/or Clinical experience
  • 2+ years of experience in an acute hospital or medical clinic setting
  • Must reside in MN or WI
  • Demands Sedentary: Lifting weight Up to 10 lbs. occasionally, negligible weight frequently

Preferred Qualifications:

  • Pre-authorization/denials experience
  • Utilization Management experience
  • Case Management experience
  • Knowledge of Milliman Criteria
  • Certified Case Manager (CCM)
  • 2+ years health insurance authorization experience
  • 2+ years experience using InterQual, MCG, or other clinical criteria
  • ONCC (Oncology Nursing Certification Corporation Online Credential Verification)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 

**PLEASE NOTE** The sign-on bonus is only available to external candidates.  Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus.  

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.