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.
Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Preservice Review Nurse RN at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You’ll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact? You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. This position must work on PST schedule.
Required Qualifications: Undergraduate degree or equivalent experience Unrestricted RN license required in state of residence 1+ years of Managed Care and/or Clinical experience Work Pacific Standard Time Schedule (PST) Preferred Qualifications: Compact RN License WA State RN License Certified Case Manager (CCM) Pre-authorization experience Utilization Management experience Case Management experience Knowledge of Milliman Criteria
Determine the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination Identify solutions to non-standard requests and problems Translate concepts into practice Act as a resource for others; provide explanations and information on difficult issues It feels great to have autonomy, and there’s also a lot of responsibility that comes with it. In this role, you’ll be accountable for making decisions that directly impact our members. And at the same time, you’ll be challenged by leveraging technologies and resources in a rapidly-changing, production-driven environment.
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