Remote Preservice Review Nurse RN, MA

UnitedHealthcare

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Requisition Number: 2182006
Job Category: Nursing
Primary Location: Boston, MA
(Remote considered)

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work.SM 

You’re empowered to do your best by supporting Optum Government Solutions Massachusetts (MA) Long Term Services and Supports (LTSS) Third Party Administration (TPA) program. Supporting the Commonwealth of Massachusetts, the MALTSS TPA program manages several elements of MassHealth’s LTSS program, including prior authorization, provider enrollment and credentialing, program integrity, and quality improvement.  The Preservice Review Nurse RN is responsible for performing pre-service/prior authorization clinical coverage review of Personal Care Attendant Program or services. Works closely with managers and peers.

If you currently reside in the state of Massachusetts, you’ll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Determine the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
  • Identify solutions to non-standard requests and problems
  • Participates in regular meetings to collaborate with supporting leadership and team to ensure operational efficiency.
  • Assures performance adheres with established quality standards, evidenced based practice guidelines and departmental benchmarks and workflows
  • Act as a resource for others; provide explanations and information on difficult issues
  • Represents the MA MLTSS program in a positive, solution focused manner that embodies our corporate values: Integrity, Compassion, Relationships, Innovation and Performance
  • Minimum 10% travel within the state of MA

What are the reasons to consider working for UnitedHealth Group?   Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
  • More information can be downloaded at: http://uhg.hr/uhgbenefits

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:

  • Associate Degree (or higher) in Nursing
  • Unrestricted RN license required in state of Massachusetts
  • 3+ years of Clinical experience and/or Managed Care
  • Reside in the state of Massachusetts
  • Designated workspace and access to install secure high-speed internet via cable or DSL in home

Preferred Qualifications:

  • Prior-Authorization experience
  • Utilization Management experience
  • Previous Community based nursing in long term support service
  • Strongly prefer Personal Care Attendant Program experience
  • Medicare/Medicaid experience
  • Proficient with Microsoft Office programs, including Word, Excel, PowerPoint
  • Possess basic math skills, including proficiency in fundamental arithmetic operations and the ability to work with numbers
  • Excellent communications skills, including the ability to write clearly, succinctly and in a manner that appeals to a wide audience
  • Excellent time management, organizational, and prioritization skills with ability to balance multiple priorities

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