Preservice Review Nurse RN - Musculoskeletal - 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 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.

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

Primary Responsibilities:

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

Schedule: 8:00am - 4:30pm OR 8:30am - 5:00pm in your time zone, Monday - Friday.

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:

Current and active unrestricted (RN) Nursing License in your state of residence

3+ years of Nursing experience

1+ years of experience working as a Nurse in area of Musculoskeletal nursing or Prior-Authorizations.

Knowledge of the clinical criteria (e.g. CMS, InterQual, MCG, etc.).

Proficiency in operating computers applications

Access to high speed internet (Broadband Cable, DSL or Fiber) from home

Dedicated work space from home

Preferred Qualifications:

2+ years of Prior Authorization experience

2+ years of Musculoskeletal experience as a main part of your job

Managed Care experience

Proven excellent interpersonal skills

Proven excellent verbal and written communications skills

*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 $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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