RN MSK Preservice Review Nurse 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. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Requirements
- Associates, Bachelors or equivalent in Nursing
- Current and active unrestricted Nursing License or certification
- 3+ years of experience, with 1+ years of Musculoskeletal, or Pre-Authorization related experience
- Knowledge of the clinical criteria (e.g. CMS, InterQual, etc.).
- Proficiency in operating computer applications
- Willing to work an occasional Saturday if requested by the business
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Nice To Haves
- Medicare Pre-Authorization experience
- Managed Care experience
- Proven excellent interpersonal skills
- Proven excellent verbal and written communications skills
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
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
