Preservice Review Nurse RN

Job Description

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.

General Job Profile :

• Generally work is self-directed and not prescribed
• Works with less structured, more complex issues
• Serves as a resource to others

You'll enjoy the flexibility to work remotely

Primary Responsibilities :

Functional Competencies

Determine 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

Review / 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)

Identify relevant information needed to make medical or clinical determinations

Demonstrate understanding of business implications of clinical decisions to drive high quality of care

Meet / exceed established productivity goals

Ask critical questions to ensure member / customer centric approach to work

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 :

Preferred Qualifications :

Pay 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.