Remote Preservice Review Nurse LPN , NV

Optum

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Requisition Number: 2175171
Job Category: Nursing
Primary Location: Las Vegas, NV
(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 and help people live healthier lives while doing your life’s best work.(sm) 

It feels great to have autonomy and there’s also a lot of responsibility that comes with it. In this role, you’ll be accountable for making decisions that directly impact our members. And at the same time, you’ll be challenged by leveraging technologies and resources in a rapidly changing, production-driven environment.

The Preservice Review LPN is responsible for performing the completion of the denial letter process for adverse determinations. This requires notification to members and/or providers, using applicable benefit plan documents, and nationally recognized clinical guidelines and criteria. The LPN is responsible for providing appeal and peer to peer information and collaborates with the Medical Director on finalized letter language.

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

Primary Responsibilities:

  • Review medical director rationale on adverse determinations
  • Ensure correct decisioning rationale has been entered in case.  Review letter language for correct grammar, spelling and punctuation. Verify it meets CMS requirements for readability level
  • Communicate various benefit determinations to health care providers and/or members and advise of appeal rights
  • Extend peer to peer opportunities
  • Act as a resource for others with less experience

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:

  • High school diploma, GED or higher
  • Current unrestricted LPN/LVN license in the state of residency
  • 3+ years of LPN experience with direct patient care
  • Experience with Microsoft Office applications
  • Flexible with work hours in Pacific Time Zone
  • Availability to work one weekend every 6-8 weeks
  • Dedicated home office space with access to high-speed Internet
  • Ability to work within multiple platforms and sites

 

Preferred Qualifications:

  • Authorization experience
  • Familiarity with Milliman Care Guidelines or Interqual
  • Bilingual (English/Spanish)

Careers at OptumCare. We’re on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we’re creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life’s best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

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. 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