Registered Nurse Jobs Working from Home

By | September 27, 2022

Job Responsibilities : Prior Authorization RN – Spine Procedures – Telecommute

Salary : $53,300 – $95,100 a year

Company : Optum

Location : Remote US

For those who want to invent the future of health care here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing
your life’s best work.(sm)
The Prior Authorization/Preservice Review RN is responsible for the review of Spine Procedures and Pain requests to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Review of Spine Procedures and Pain evaluations and progress reports to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria for either initial or continued authorization
  • Review documentation submitted to support the medical necessity of the request
  • Ensure clinical information submitted for peer review and entered into patient’s electronic record is the most accurate and up to date
  • Interacting with the physician to ensure the most appropriate and highest quality of care is recommended
  • Preparation and filing of reports outcome data and records
  • Collaborate with Contract Assistants working on their team to ensure that responses to authorization requests are responded to within Regulatory time frames
  • Maintains contact and communicates with insurance companies to apprise them of case activity case direction or receive authorization services
  • Maintains contact with all parties involved in case necessary for case management for the client
  • Acts as clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to maximize quality of patient care as well as effectively manage length of stay and utilization resources as appropriate
  • Adheres to all documentation and performance guidelines
  • Other duties as assigned
Required Qualifications:
  • Current unrestricted RN license in state of residence
  • 3+ years of hands-on clinical experience as a Registered Nurse (RN) with a broad range of clinical experiences
  • 1+ year of prior authorization/preservice review experience
  • 1+ years of orthopedics experience
  • Demonstrate a proficiency in computer skills including Microsoft Word with the ability to navigate a Windows environment
  • Strong written and verbal communication skills
  • Attention to detail organizational skills and multitasking abilities will be keys to success
  • Designated workspace and access to install secure high-speed Internet via cable / DSL in home
Preferred Qualifications:
  • BSN
  • Compact RN license
  • Medicare experience
  • Spine experience
  • Pain Management experience
  • Case management experience
  • Milliman (MCG) CMS and/or InterQual criteria experience
  • Managed Care
  • Experience in medical necessity review medical record review medical record audits
  • Experienced in collaborating with physicians and other healthcare professionals
  • Knowledge of ICD 10 and CPT coding
  • Willing and able to obtain additional State RN Licensure(s) if necessary
To protect the health and safety of our workforce patients and communities we serve UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information or guide health and lifestyle choices or manage pharmacy benefits for millions our first goal is to leap beyond the status quo and uncover new ways to serve. Optum part of the UnitedHealth Group family of businesses brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you that means working on high performance teams against sophisticated challenges that matter. Optum incredible ideas in one incredible company and a singular opportunity to do
your life’s best work.(sm)
Colorado Connecticut or Nevada Residents Only: The salary range for Colorado residents is $53300 to $95100. The salary range for Connecticut/Nevada residents is $58800 to $104600. Pay is based on several factors including but not limited to education work experience certifications etc. 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.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Keywords: Prior Authorization precertification preservice review medical necessity review RN registered nurse utilization review management spine spinal back surgery pain management case management MCG Milliman Care Guidelines InterQual Medicare managed care orthopedic telecommute work from home remote

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