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Remote RN or LPN UM Nurse – PST - Remote Eligible
Ensure compliance with established guidelines for adverse determination processes.
Seattle
Senior
$58.3k-$114.3k USD per year
3 months ago
Optum
We’re a leading health solution and care delivery organization
Job is no longer active
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✨ About The Role
- Responsible for ensuring the integrity of the adverse determination processes and accuracy of clinical decision making
- Evaluate out-of-network and tertiary denials for accessibility within the network
- Perform quality assurance audits on each denial recommendation to ensure compliance with established guidelines
- Collaborate with UM compliance for continued quality improvement efforts for adverse determinations
- Identify gaps in training or processes impacting the overall compliance of adverse determinations and communicate effective performance improvement solutions
⚡ Requirements
- Experienced nurse with a minimum of 5-8 years in care management, utilization review, or discharge planning
- Strong communication skills and a commitment to providing superior customer service
- Ability to work independently and remotely, adhering to established guidelines and protocols
- Active, unrestricted Registered Nurse or Licensed Practical Nurse license through the State of Washington or Multistate License
- Comfortable collaborating with medical directors and UM compliance for continued quality improvement efforts
Remote RN or LPN UM Nurse – PST - Remote Eligible
Seattle
$58.3k-$114.3k USD per year
Vocational Nurse
Job is no longer active
About Optum
We’re a leading health solution and care delivery organization