Preservice Review Nurse RN - Remote Eligible

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 Home Health services. Works closely with managers and peers.

If you currently reside in the state of Massachusetts, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Determine the appropriateness of inpatient and outpatient 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 required in state of Massachusetts
• 3+ years of Managed Care and/or clinical experience
• Reside in the state of Massachusetts
• Designated workspace and access to install secure high-speed internet via cable or DSL in home

Preferred Qualifications:

• Prior-Authorization experience
• Utilization Management experience
• Group Adult Foster Care (GAFC) experience
• Medicare/Medicaid experience preferred
• Proficient with Microsoft Office programs, including Word, Excel, PowerPoint
• Excellent communications skills, including the ability to write clearly, succinctly and in a manner that appeals to a wide audience
• Excellent time management, organizational, and prioritization skills with ability to balance multiple priorities

*All Telecommuters 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). 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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.