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 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. The Preservice Review Nurse RN is responsible for evaluating the appropriateness of inpatient and outpatient services based on medical guidelines and benefit determination, identifying solutions to non-standard requests and problems, and collaborating with leadership and team members to ensure operational efficiency. The role requires adherence to quality standards, evidence-based practice guidelines, and departmental benchmarks, as well as acting as a resource for others and representing the MA MLTSS program positively. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. 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 • Participate 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 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: • Must be a Registered Nurse (RN) with a current, unrestricted RN License in the state of Massachusetts • 3+ years of Managed Care and/or clinical experience • Designated workspace and access to install secure high-speed internet via cable or DSL in home • Must be able/willing to travel up to 10% of the time if business needs dictate Preferred Qualifications: • Prior-Authorization experience • Utilization Management experience • Home Health Agency experience • Medicare/Medicaid experience • Proficient with Microsoft Office programs, including Word, Excel, PowerPoint • Proven excellent communications skills, including the ability to write clearly, succinctly and in a manner that appeals to a wide audience • Proven excellent time management, organizational, and prioritization skills with ability to balance multiple priorities • 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 $28.94 to $51.63 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. 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. 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. Apply tot his job