Preservice Review Nurse RN -Remote
About the position
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Integrated Care Team leverages a cross-functional approach, supporting the member end to end, with close collaboration and co-management. Generally, work is self-directed and not prescribed; is able to work with less structured and more complex issues
The team will manage the full array of health care services, spanning both outpatient and Inpatient settings and with support from some specialized clinical teams. Serves as a resource to others
This new cross-functional collaboration provides an opportunity to deliver the next generation clinical model, integrating services from precertification, inpatient concurrent review, post-acute review, discharge planning, medical and behavioral care management and prevention to improve quality of care and patient outcomes. Candidates for this position would be required to support cross-training to multiple roles (PA, ICM, PACM, DCM) to support fluctuating inventory within the ICT
Responsibilities
• Perform initial and ongoing reviews pertaining to primary role (PA, ICM, DMC, PACM), appropriately applying clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and sending to Medical Directors if review is necessary for determining an adverse determination
• Collaborate with Medical Directors, clinical peers and Health Plan partners on performing appropriate clinical decision making and/or referrals
• Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
• Follow all Standard Operating Procedures in end-to-end management of cases
• Participate in team meetings, education discussions and related activities
• Maintain compliance with Federal, State and accreditation organizations
Requirements
• Active, Unrestricted Compact RN License or KY Single State
• 3+ years total experience including recent clinical experience in an inpatient/acute setting, long-term care, acute rehabilitation, or skilled nursing facilities
• Proficient in Microsoft Office Tools (Word, Excel, Outlook, Teams)
• Designated Distraction free workplace with access to high-speed internet
• Ability to work independently
Nice-to-haves
• A bachelor’s degree
• 2+ years case management
• Experience performing discharge planning valuable
• Critical care experience
• Family Practice experience
• Skilled Nursing or Rehab experience
• Background that involves utilization review and InterQual favorable
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Benefits
• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
Apply Now
Apply Now
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Integrated Care Team leverages a cross-functional approach, supporting the member end to end, with close collaboration and co-management. Generally, work is self-directed and not prescribed; is able to work with less structured and more complex issues
The team will manage the full array of health care services, spanning both outpatient and Inpatient settings and with support from some specialized clinical teams. Serves as a resource to others
This new cross-functional collaboration provides an opportunity to deliver the next generation clinical model, integrating services from precertification, inpatient concurrent review, post-acute review, discharge planning, medical and behavioral care management and prevention to improve quality of care and patient outcomes. Candidates for this position would be required to support cross-training to multiple roles (PA, ICM, PACM, DCM) to support fluctuating inventory within the ICT
Responsibilities
• Perform initial and ongoing reviews pertaining to primary role (PA, ICM, DMC, PACM), appropriately applying clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and sending to Medical Directors if review is necessary for determining an adverse determination
• Collaborate with Medical Directors, clinical peers and Health Plan partners on performing appropriate clinical decision making and/or referrals
• Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
• Follow all Standard Operating Procedures in end-to-end management of cases
• Participate in team meetings, education discussions and related activities
• Maintain compliance with Federal, State and accreditation organizations
Requirements
• Active, Unrestricted Compact RN License or KY Single State
• 3+ years total experience including recent clinical experience in an inpatient/acute setting, long-term care, acute rehabilitation, or skilled nursing facilities
• Proficient in Microsoft Office Tools (Word, Excel, Outlook, Teams)
• Designated Distraction free workplace with access to high-speed internet
• Ability to work independently
Nice-to-haves
• A bachelor’s degree
• 2+ years case management
• Experience performing discharge planning valuable
• Critical care experience
• Family Practice experience
• Skilled Nursing or Rehab experience
• Background that involves utilization review and InterQual favorable
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Benefits
• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
Apply Now
Apply Now