Optum is seeking a Certified Surgical Technologist for a job in Shakopee, Minnesota.
Job Description & Requirements
- Specialty : Certified Surgical Technologist
- Discipline : Allied Health Professional
- Duration : Ongoing
- Employment Type : Staff
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.
Positions in this family require a current, unrestricted nursing license (i.e. RN) in the applicable state, as indicated in the function description and / or job title.
Positions in this function require various nurse licensure and certification based on role and grade level. Licensure includes RN, depending on grade level, with current unrestricted licensure in applicable state.
If you are located in CST or MST Time Zones, you will have the flexibility to work remotely
as you take on some tough challenges.General Job Profile :
Generally work is self-directed and not prescribedWorks with less structured, more complex issuesServes as a resource to othersYou'll enjoy the flexibility to work remotely
from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities :
Assesses and interprets customer needs and requirementsIdentifies solutions to non-standard requests and problemsSolves moderately complex problems and / or conducts moderately complex analysesWorks with minimal guidance; seeks guidance on only the most complex tasksTranslates concepts into practiceProvides explanations and information to others on difficult issuesCoaches, provides feedback, and guides othersActs as a resource for others with less experienceFunctional Competencies
CPS_Conduct Non-Clinical Research to Support DeterminationsDetermine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial) -Validate that cases / requests for services require additional research
Identify and utilize appropriate resources to conduct non-clinical research (e.g., benefit documents, evidence of coverage, state / federal mandates, online resources)Prioritize cases based on appropriate criteria (e.g., date of service, urgent, expedited)Ensure compliance with applicable federal / state requirements and mandates (e.g., turnaround times, medical necessity)CPS_Review Existing Clinical DocumentationReview / interpret clinical / medical records submitted from provider (e.g., office records, test results, prior operative reports) -Identify missing information from clinical / medical documentation, and request additional medical or clinical documentation as needed (e.g., LOI process, phone / fax)
Review and validate diagnostic / procedure / service codes to ensure their relevance and accuracy, as applicable (e.g., PNL list, EPAL list, state grid, LCDs, NCDs)Identify and validate usage of non-standard codes, as necessary (e.g., generic codes)Apply understanding of medical terminology and disease processes to interpret medical / clinical recordsMake determinations per relevant protocols, as appropriate (e.g., approval, denial process, conduct further clinical or non-clinical research)Review care coordinator assessments and clinical notes, as appropriateCPS_Conduct Clinical Research to Support DeterminationsIdentify relevant information needed to make medical or clinical determinations
Identify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG, medical policies, Coverage Determination Guidelines [CDG], National Comprehensive Cancer Network [NCCN], state / federal mandates) -Review / interpret other sources of clinical / medical information to support clinical or medical determinations (e.g., previous diagnoses, authorizations / denials, case management documentation)Obtain information from patients, providers and / or care coordinators as needed to verify services rendered and / or recommend additional options (e.g., Organization Determination Appeals and Grievance [ODAG], steerage calls)Apply knowledge of applicable state / federal mandates, benefit language, medical / reimbursement policies and consideration of relevant clinical information to support determinationsCollaborate with applicable internal stakeholders as needed to drive the clinical coverage review process (e.g., Medical Directors and their staff, Optum, UHC, Account Management)CPS_Make Final Determinations Based on Clinical and Departmental GuidelinesDemonstrate understanding of business implications of clinical decisions to drive high quality of care
Understand and adhere to applicable legal / regulatory requirements (e.g., federal / state requirements, DOI, HIPAA, CHAP, CMS, NCQA / URAC accreditation)Ask critical questions to ensure member- and customer-centric approach to workIdentify and consider appropriate options to mitigate issues related to quality, safety or risk, and escalate to ensure optimal outcomes, as neededUtilize evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business resultsIdentify and implement innovative approaches to the practice of nursing, in order to achieve or enhance quality outcomesUse appropriate business metrics to optimize decisions and clinical outcomesPrioritize work based on business algorithms and established work processes (e.g., assessments, case / claim loads, previous hospitalizations, acuity, morbidity rates, quality of care follow up)CPS_Achieve and Maintain Established Productivity and Quality GoalsMeet / exceed established productivity goals
Adhere to relevant quality audit standards in performing reviews, making determinations and documenting recommendations -Manage / prioritize workload and adjust priorities to meet quality and productivity goalsCPS_Drive Effective Clinical Decisions Within a Business EnvironmentAsk critical questions to ensure member / customer centric approach to work
Identify and consider appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalate to ensure optimal outcomes, as neededUtilize evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business resultsIdentify and implement innovative approaches to the nursing role, in order to achieve or enhance quality outcomes and / or financial performanceUnderstand and operate effectively / efficiently within legal / regulatory requirements (e.g., HIPAA, healthcare reform, URAC / NCQA / ERISA / state accreditation)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 Qualification :
Current unrestricted RN license in the state of residency3+ years of RN experience in an acute settingAdvanced computer proficiency (Microsoft Word, Outlook, and Internet)Flexible with work hours - hours / days can change as needed for the businessOpen to required weekend rotation schedule in the futureReside in CST or MST time zonePreferred Qualification :
3+ years of experience as an RN in utilization managementCompact RN licenseAll employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyPay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Optum Job ID #2313121. Posted job title : Preservice Review Nurse RN - Remote in CST or MST Time Zones
About Optum
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 benefits listed below are provided as a general overview. They are not intended to represent the full scope of programs available, nor do they guarantee coverage for all employees
Benefits
Holiday PayContinuing Education401k retirement planSick payWellness and fitness programsEmployee assistance programsMedical benefitsDental benefitsVision benefitsLife insurance