Remote Preservice Review Nurse RN – Musculoskeletal – NC

Optum

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Requisition Number: 2233190
Job Category: Nursing
Primary Location: Charlotte, NC
(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 they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

If you reside in North Carolina, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities: 

  • Review of Musculoskeletal (MSK) care requests to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria
  • Review documentation submitted to support the medical necessity of the request
  • Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
  • Maintains contact with all parties involved in case necessary for case management for the client
  • Adheres to all documentation and performance guidelines
  • Assesses and interprets customer needs and requirements
  • Identifies solutions to nonstandard requests and problems
  • Works with minimal guidance; seeks guidance on only the most complex tasks

Schedule:  8:00am – 4:30pm OR 8:30am – 5:00pm EST, Monday – Friday. 

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:  

  • Current and active unrestricted (RN) Nursing License in North Carolina
  • 3+ years of Nursing experience
  • 1+ years of experience working as a Nurse in area of Musculoskeletal nursing or Prior-Authorizations.
  • Knowledge of the clinical criteria (e.g. CMS, InterQual, MCG, etc.).
  • Proficiency in operating computers applications
  • Access to high speed internet (Broadband Cable, DSL or Fiber) from home
  • Dedicated work space from home
  • Reside in North Carolina

Preferred Qualifications:

  • 2+ years of Prior Authorization experience
  • 2+ years of Musculoskeletal experience as a main part of your job
  • Managed Care experience
  • Proven excellent interpersonal skills
  • Proven excellent verbal and written communications skills

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

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.