Remote LVN UM Delegation Oversight, CA

Optum

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Requisition Number: 2194648
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.

Work Hours PST 8am-5pm Monday – Friday

Primary Responsibilities: 

  • 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
  • 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

 

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 Nurse program
  • Current LVN license
  • 2+ years of clinical experience working as an LVN/LPN

 

Preferred Qualifications: 

  • 3+ years of experience working as an LVN/LPN
  • 2+ years of care management, utilization review or discharge planning experience
  • 1+ years of utilization management experience especially Prior Authorization
  • 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