Remote Preservice Review Nurse RN, NY

Optum

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Requisition Number: 2223792
Job Category: Nursing
Primary Location: White Plains, NY
(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. 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. 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. 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

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:

  • Undergraduate degree or equivalent experience
  • Current and active unrestricted Nursing License or certification
  • 3+ years of experience, with 1+ years of which must have been Musculoskeletal, Case Management, or Pre-Authorization related
  • Knowledge of the clinical criteria (e.g. CMS, InterQual, etc.).
  • Proficiency in operating computers applications

Preferred Qualifications:

  • Medicare Pre-Authorization experience
  • 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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.