Remote LVN, Delegation Oversight

Optum

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Requisition Number: 2194650
Job Category: Nursing
Primary Location: El Segundo, CA
(Remote considered)

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. 

 

The LVN, Clinical Services Delegation Oversight (Telecommute) is under the direction of the Manager of Delegation Oversight, this position is responsible for activities that support Optum Clinical Services compliance with regulatory and delegation contractual requirements as outlined in the Clinical Services Delegation Oversight framework that includes management of delegation oversight and regulatory audits, internal monitoring, corrective action plan development and resolution.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

  • Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each internal and external customer
  • In collaboration with the Manager of Delegation Oversight, manages delegation oversight and regulatory audits
  • Leverages knowledge of clinical services regulatory and compliance requirements to represent Optum Clinical Services appropriately while managing delegation oversight audits
  • Serves as a liaison between Health Plan delegated entities and Clinical Services Operational teams (Utilization Management and Case Management)
  • Serves as a liaison between Delegation Oversight and cross-functional areas/departments across the organization
  • Serves as a subject matter expert regarding Clinical Services Policies and Procedures
  • Participates in educational programs to enhance care management (UM and CM) Oversight knowledge
  • Performs internal monitoring/auditing process as applicable
  • Performs Appeal processing as applicable
  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

 

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: 

  • Graduation from an accredited Licensed Vocational/Practical Nurse program
  • Current LVN/LPN license in State of Residence
  • 3+ years of clinical experience working as an LVN/LPN
  • 1+ years of care management, or utilization review (prior authorization) experience

 

Preferred Qualifications: 

  • Experience in an HMO or experience in a Managed Care setting
  • A base knowledge of requirements for Medicare, Medi-Cal and Commercial lines of business

 

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $18.80 to $36.78 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy