RN MSK Preservice Review Nurse Remote

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.

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