Sr Preservice Review Nurse RN – Remote

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

Primary Responsibilities:

• Development and annual review/approval of team training materials; CCR Subject Matter Expert
• SME: CCR Team process and documents (SOP, JA, Review Guides, Policy, Procedure) – focused review and updates to drive standardization, high quality and efficiency
• Analyze, communicate results/trends, develop action plans and execute strategy for key reports examples: PowerBI , Daily Defect, TAT Report and others
• Trend, analyze and improve processes and suggests improvements
• Meeting CCR department Performance Guarantees (PGs), Service Level Agreements (SLAs), and regulatory requirements.
• Leads or participates in projects including but not limited to internal and external audit, quality improvement, compliance, implementation
• Participate in key projects and meetings to champion and execute for business standardization and flawless execution.
• People Leader (ex. Sup, Mgr) coverage back up
• Manages CCR Team escalated requests and concerns
• Subject Matter Expert (SME): resource for complex issues and process/application questions
• Facilitate employee engagement activities
• Create and sustain a positive supportive work environment/experience for our team
• Support and endorses business goals, provide recommendations for improvement
• Mentoring, coaching, team education: New hire preceptor, time management, skill, processes, professional development, etc.
• Carry a partial caseload volume TBD by Directors; 0–50%,
• Positive attitude
• Flexible schedule per business needs and flexible responsibilities

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:

• Registered Nurse with active unrestricted compact license
• Currently an ECS Clinical Coverage Review (CCR Team) Clinician or CCR Supervisor within the applicable within the E&I line of business
• Outstanding historical performance in the CCR role (quality and production)
• 2+ years of experience with Prior Authorization UM
• Expertise with the ICUE UM application
• Proficiency in Word, Excel, Outlook, Power Point and Teams
• Proficient in application of InterQual clinical criteria and medical policy guidelines
• Proven solid communication, presentation and writing skills

Preferred Qualifications:

• Advanced Degree – clinical or business
• Experience precepting/training CCR Team Members

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 

The hourly range for this role is $34.42 to $67.60 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. 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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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