Preservice Review Nurse RN - Radiation Oncologyremote - Remote Eligible

Outpatient 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.

This role will be performing outpatient clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration for outpatient procedures and services.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. This is a Monday through Friday position during standard business hours in the local time zone. Rotating Saturdays may be required, approximately every 6 to 12 weeks.

Primary Responsibilities:

• Function as a member of a self-directed team to meet specific individual and team performance metrics
• Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations
• Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
• Act as a resource for others with less experience
• Work independently and collaborating with Medical Directors and non-clinical partners
• Adapt to a highly changing environment and a heavy case load

This position may require active and unrestricted nursing licensure in multiple US States. Selected candidate must be willing and able to obtain and maintain multiple state licensure. Application fees and filing costs will be paid for by UHG.

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 your state of residence
• Ability to obtain licensure in other states as needed
• 2+ years of Radiation Oncology experience as a Nurse
• Computer proficiency, to include solid data entry skills and the ability to navigate a Windows environment
• Access to high speed internet from home (Broadband cable, Fiber or DSL)
• Dedicated workspace for home office set up

Preferred Qualifications:

• OCN Certification
• Chemo/Bio Certification
• Certified Case Manager (CCM)
• 7+ years of Radiation Oncology experience
• ICD Coding experience or solid knowledge of codes
• NCCN experience
• Background in preservice review/utilization review/utilization management

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). 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.