Preservice Review Nurse- Behavioral Health

UnitedHealth Group • Clearwater, FL

361d • $28 - $56

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 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.

Requirements

• Current unrestricted RN license in the state of residency or compact state
• Professional experience in direct patient care
• Proven exemplary clinical documentation skills; critical thinking skills
• Demonstrated proficiency in computer skills - Excel, Microsoft platforms, Outlook, clinical platforms
• Designated secure workspace and access to install secure high speed internet via cable/DSL in home

Nice To Haves

• Bachelor's degree
• Behavioral Health experience
• 2+ years of RN experience including experience in an inpatient/acute setting
• Demonstrated background involving utilization review for an insurance company or experience in case management
• Proven excellent communication skills both verbal and written
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Responsibilities

• Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
• Function as a member of a self-directed team to meet specific individual and team performance metrics
• Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines
• Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
• Acts as a resource for others with less experience
• Work independently and collaborating with Medical Directors and non-clinical partners
• Adapt to a highly changing environment and a heavy case load

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees