Preservice Review Nurse Rn - Remote Eligible

Requisition Number: 2245201
Job Category: Nursing
Primary Location: Boston, MA, US
(Remote considered)

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’re empowered to do your best by supporting Optum Government Solutions Massachusetts (MA) Long Term Services and Supports (LTSS) Third Party Administration (TPA) program. Supporting the Commonwealth of Massachusetts, the MALTSS TPA program manages several elements of MassHealth’s LTSS program, including prior authorization, provider enrollment and credentialing, program integrity, and quality improvement.

The Preservice Review Nurse RN is responsible for performing pre-service/prior authorization clinical coverage review of Personal Care Attendant Program services. Works closely with managers and peers.

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

Primary Responsibilities:

• Determine the appropriateness of community services following evaluation of medical guidelines and benefit determination
• Identify solutions to non-standard requests and problems
• Participates in regular meetings to collaborate with supporting leadership and team to ensure operational efficiency
• Assures performance adheres with established quality standards, evidenced based practice guidelines and departmental benchmarks and workflows
• Act as a resource for others; provide explanations and information on difficult issues
• Represents the MA MLTSS program in a positive, solution focused manner that embodies our corporate values: Integrity, Compassion, Relationships, Innovation and Performance
• Minimum 10% travel within the state of MA

What are the reasons to consider working for UnitedHealth Group?   Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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:

• Associate’s Degree (or higher) in Nursing
• Unrestricted RN license in the state of Massachusetts
• 3+ years of Clinical and/or managed care experience
• Willing or ability to travel within Massachusetts if business needs dictate (approximately 10% of the time)

Preferred Qualifications:

• Adult Day Health Program experience
• Day Habilitation Program experience
• Prior Authorization / Utilization Management experience
• Familiarity with Massachusetts Medicaid
• Community based nursing experience in long term support service
• Proficient with Microsoft Office programs, including Word, Excel, PowerPoint
• Proven ability to possess basic math skills, including proficiency in fundamental arithmetic operations and the ability to work with numbers
• Proven excellent communications skills, including the ability to write clearly, succinctly and in a manner that appeals to a wide audience
• Proven excellent time management, organizational, and prioritization skills with ability to balance multiple priorities

*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