LPN Utilization Mgmt - Remote - Remote Eligible

Caring. Connecting. Growing Together.

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.

This position is full-time (40 hours/week) M-F; 8-5pm PST, please include 4 10s with a mandatory Saturday is preferred.

If you are located from anywhere within the U.S. and has the ability to work PST, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Understand and follow standardized processes for managing add or change requests and implementing requests in the letter generation system
• Create and review denial letters to determine compliance with contractual and regulatory requirements of the State and Federal programs, while reviewing for efficiencies and effectiveness of procedures
• Create and review appeal letters to meet compliance with contractual and regulatory requirements of the State and Federal programs, while reviewing for efficiencies and effectiveness of procedures
• Performs internal quality control reviews on processes and activities regarding letter writing
• Identify and correct letter deficiencies
• Work independently and in a team environment
• Demonstrate high attention to detail, exceptional documentation abilities, and organizational skills
• Collaborate with our business partners, Letter Owners, and other Letter Maintenance Administrators (LMA’s) regarding letter template design and development
• Develop new templates and/or change templates for approved letter requests
• Summarize results/recommendations and present findings to supervisor
• Other duties as assigned by supervisor which fall into the scope of practice

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:

• Graduate from an accredited school of Nursing
• Current, unrestricted LPN license in state you reside
• 2+ years of experience in utilization management or (prior authorization review) nurse
• 1+ years of direct clinical patient care experience
• Experience with Microsoft Suite
• Knowledge of medical terminology

Preferred Qualifications:

• 3+ years of direct clinical patient care experience
• 1+ years of experience with medical management activities in a managed care environment
• Medicare Advantage and Medicaid experience
• Knowledge of managed care principles
• MCG knowledge - basic

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

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). The hourly pay for this role will range from $xx.xx to $xx.xx 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.