Preservice Review Nurse - Behavioral Health - Remote In Nevada - Remote Eligible

Optum Clinical Coverage Review Services

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.

Primary Responsibilities:

1. Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
2. Function as a member of a self-directed team to meet specific individual and team performance metrics
3. Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines
4. Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
5. Acts as a resource for others with less experience
6. Work independently and collaborating with Medical Directors and non-clinical partners
7. Adapt to a highly changing environment and a heavy case load

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 unrestricted RN license in the state of residency
• Professional experience in direct patient care
• Proven exemplary clinical documentation skills; critical thinking skills
• Demonstrated proficiency in computer skills - Excel, Microsoft platforms, Outlook, clinical platforms
• Designated secure workspace and access to install secure high speed internet via cable/DSL in home
• Flexible with work hours - hours/days can change as needed for the business
• Open to required weekend Sat/Sun schedules

Preferred Qualifications:

• Bachelor's degree
• Compact RN license
• 2+ years of RN experience including experience in an inpatient/acute setting
• Behavioral Health experience
• Demonstrated background involving utilization review for an insurance company or experience in case management
• Proven excellent communication skills both verbal and written

*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 re subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 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.