Financial Clearance Specialist RN – Remote near Minneapolis, MN

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.  

If you reside near Minneapolis, MN, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Principle Responsibilities:

• Identify requirements to obtain prior authorization denials for Oncology services and other medical specialties as needed
• Prioritize work per Financial Clearance Service Level Agreements (SLA) and payer deadlines to ensure all patients are cleared per standards in system policies
• Identify prior authorization requirements for service(s) by using tools, electronic resources (i.e. electronic queries, payer websites) and/or phone/fax
• Complete daily assignments per leadership direction
• Assess clinical data from medical records to obtain authorization for scheduled services
• Abstract and submit clinical data from medical records to insurance payers Utilize clinical screening criteria and reviews insurance payer medical policies to ensure patients meet medical necessity for scheduled services
• Assure the medical record has the proper physician clinical documentation to support medical necessity for the ordered service
• Monitor for continued authorization, communicates results and opportunities to nurses, physicians, finance, case managers, and payers
• Complete work effectively and efficiently maintaining quality and production standards Maintains knowledge of and complies with regulatory requirements, organizational standards, and policies, procedures, and workflows related to areas of responsibility
• Evaluate potential denials or payment issues and initiates communication with physician or clinician regarding next steps
• Prepare and facilitates appeals for denied claims, as appropriate
• Escalate peer to peer requests to the ordering physician, and provide appropriate insight to the provider regarding clinical documentation to support medical necessity for the ordered service
• Summarize denial trends and report to leadership
• Complete work effectively and efficiently maintaining quality and production standards
• Training/mentoring and daily workflow coaching to less experienced team members on all aspects of the prior authorization process
• Other duties as assigned

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:

• Active licensed Registered Nurse in the state of Minnesota and/or Wisconsin
• 3+ years of Managed Care and/or clinical experience
• 2+ years of experience in an acute hospital or medical clinic setting
• Must reside in Minnesota or Wisconsin
• Demands Sedentary: Lifting weight up to 10 lbs. occasionally, negligible weight frequently

Preferred Qualifications:

• Bachelor’s Degree in nursing (or higher)
• 2+ years of health insurance authorization experience
• 2+ years of experience using InterQual, MCG, or other clinical criteria
• Certified Case Manager (CCM)
• Knowledge of Milliman Criteria

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 

 

The salary range for this role is $59,500 to $116,600 annually 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. 

 

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. 

 

 

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