Remote LVN, UM Delegation Oversight

Optum

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Requisition Number: 2214768
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. 

 

Under the general direction of the Delegation Oversight Manager, this position is responsible for coordinating all components of Health Plan Delegation Oversight audits and performing internal quality reviews for Case Management and Utilization Management.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. The work hours are 8am-5pm PST.

 

Primary Responsibilities: 

  • Prepares and submits of pre-audit documentation as outlined on Health Plan audit tools
  • Communicates with Health Plan auditors related to audit documents and processes
  • Communicates and collaborates across the organization to gather necessary documentation to meet audit requirements
  • Facilitate onsite/virtual/desktop compliance audit reviews to ascertain regulatory requirements adherence
  • Participates in performance improvement activities
  • Conduct comprehensive internal audit of the end-to-end utilization management process
  • Conduct focused internal audits of a specific element or process change based on identified trends or new process implementation

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
  • 2+ years of clinical experience working as an LVN/LPN
  • 1+ years of utilization management experience especially Prior Authorization

Preferred Qualifications: 

  • 3+ years of experience working as an LVN/LPN
  • 2+ years of care management, utilization review or discharge planning experience
  • Experience in an HMO or experience in a Managed Care setting
  • Base knowledge of requirements for Medicare, Medi-Cal and Commercial lines of business

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

 

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $19.47 to $38.08 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.

 

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.