Remote Senior Clinical Review Nurse – Maine License

Optum

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Requisition Number: 2203285
Job Category: Nursing
Primary Location: Augusta, ME
(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.

 

The Senior Clinical Review Nurse is responsible for using a variety of electronic systems. They will receive, review, and research, requests from community providers for prior authorization of medical supplies and services.  The Senior Clinical Review Nurse will utilize sound clinical judgement, critical thinking skills, appropriate criteria, and knowledge of best practice to ensure accurate decisions of requests for medical supplies and services.

 

Work Schedule:  Monday to Friday 8:00 AM EST to 5:00 PM EST.

If you have a Maine, RN license, you’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities: 

  • Monitor electronic prior authorization queues: process prior authorization requests, based on SLA timelines, and make clinical and eligibility determinations
  • Developing a working knowledge base of MaineCare policies, Industry best practice standards, and medical coding accuracy
  • Participate in the preparation for and attend administrative hearings, providing testimony based on clinical documentation, policy requirements, and eligibility (Court like proceedings)

 

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: 

  • Active State of Maine Nursing License with no restrictions
  • 3+ years of clinical nursing experience
  • Dedicated work area established that is separated from other living areas and provides information privacy
  • Access to high speed internet (DSL or Cable)

 

Preferred Qualifications:  

  • RN with four-year degree, will consider two-year degree with relevant experience
  • Familiarity with Prior Authorization process and requirements
  • Knowledge of Medicaid regulations

*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 salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $70,200 to $137,800 annually. 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.