Remote Sr Preservice Review Nurse RN – Arizona

Job Overview

  • Clinical License RN
  • State(s) AZ

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.

 

The Integrated Care Team is a cross-functional approach, supporting the member end to end, with close collaboration and co-management. 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. This new cross-functional collaboration provides an opportunity to deliver the next generation clinical model, integrating services from precertification, inpatient concurrent review, discharge planning, care management and prevention to improve quality of care and patient outcomes.

 

This is a Telecommute/Work from home position from anywhere in the US.  Primary schedule is Monday – Friday during normal business hours, with potential for evening or weekend hours as needed.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

  • Assist Managers and Supervisors with escalated issues
  • Assist in development of training materials; acts as Subject Matter Expert
  • Fields questions and serves as a resource for Clinicians and non-clinicians
  • Reviews and updates job aids to maximize quality and productivity
  • Trend, analyze and improve processes and suggests improvements
  • Participate in quality improvement initiatives
  • Leads or participates in special projects, as required
  • Subject Matter Expert (SME): staff resource for complex issues and process/application questions SME: Process/Documents (SOP, JA, Review Guides, Policy, Procedure)
  • Analyze, communicate results/trends, and collaborate with leaders to develop action plans for key reports: ECAR, Daily Defect, TAT Report and additional other team specific reports i.e.; PDN Actively participate in key projects and meetings to champion business standardization and flawless execution. Report outcomes to leadership team i.e.; Supervisory Advisory
  • Committee, MACRO Governance, SOP/Job Aide Meetings, others
  • Supervisor coverage back up
  • Facilitate employee engagement activities
  • Support and endorses business goals, provide recommendations for improvement
  • Provide input into the MAP process when applicable
  • Mentoring, coaching, staff education: time management, skill, processes, professional development, etc
  • Carry a partial caseload volume TBD by Directors; 0–50%

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:

  • Undergraduate degree or equivalent experience
  • Registered Nurse with current unrestricted license in the state of residence
  • 3+ years of experience as Registered Nurse
  • 1+ years of experience with medical management, prior authorization, utilization management/review or concurrent review
  • Experience mentoring others, transferring knowledge to peer
  • ICM experience
  • Proficient in using clinical criteria and medical policy guidelines
  • Solid working knowledge of the health insurance industry, products and service and the managed care environment
  • Solid computer skills including word processing, database management
  • PC proficiency in Word, Excel, Outlook, Power Point and WebEx
  • Demonstrated ability to prioritize and manage multiple tasks
  • Proven excellent organizational skills and attention to detail
  • Proven customer service skills
  • Proven excellent interpersonal and motivational skills
  • Proven ability to work independently and make sound decisions in a fast paced environment
  • Proven solid communication, presentation and writing skills
  • Proven excellent Problem Solving and analytical skills
  • Access to high speed internet and a dedicated workspace from home

 

Preferred Qualification:

  • Experience working with Integrated Care Team

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington or Washington, D.C. Residents Only: The hourly range for this role is $33.75 to $66.25 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

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.

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

 

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