Easter Seals Jobs

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.

This Senior Preservice Review RN reports into the Director, supports 35 to 50 nurses. This role serves as key resource/SME for complex issues and process/application questions.

If you possess a Compact License, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Serves as key resource/SME for complex issues and process/application questions.

• Mentors existing Preservice Nurses – leads by example, has effective communication skills, is flexible and displays positive attitude. Supports and endorses stated goals, provides recommendations for improvements and provides input into the MAP Process.

• Assists with navigating through clinical platforms and Microsoft Office Products.

• Actively participates in key meetings: Clinical Leadership, SOP/Job Aide Meetings, new initiatives, technical rollouts, etc.

• Manages and follow-up with key reports: ECAR, Daily Defect, TAT Report and additional reports as designated

• Supports and champions business standardization and flawless execution of initiatives

• Champions Employee Engagement opportunities; Escalates to Management issues or obstacles that impede employee engagement

• 0% - 25% of caseload responsibility, however, must stay engaged and knowledgeable on front-line case responsibilities/activities

• Inventory reporting

• Compliance/Inventory Management

• Training

• New/changing processes

• Identified process or clinical gaps

• SOP/JA Updates & Revisions

• Supports new initiatives (OCM, Vis, etc.)

• Assists CAC team; liaison to CAC Sups

• Auditing

• Auditing fallout/errors

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 licensure in state of residence

• 3+ years of experience as a Registered Nurse

• 2+ years in supporting applicable line of business

• 2+ years of experience as a Preservice Review/Prior Authorization RN

• Subject Matter Expertise (SME) in current work

• Knowledgeable in Prior Authorization review hierarchy

• Customer/Client/State P&P’s/SOPs, etc.

• State-specific contracts & regulations

• Proficient in using clinical criteria and medical policy guidelines

• Solid working knowledge of the health insurance industry, products and service and the managed care environment

• Experience training others, transferring knowledge to peers

• Computer skills including word processing, database management, PC proficiency in Word, Excel, Outlook, Power Point and WebEx

• Solid presentation skills/comfortable presenting to various levels of the organization

• Distraction free workspace in home for home office

• Access to High Speed/Broadband internet service

Preferred Qualifications:

• CPT and ICD-10 coding experience

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The hourly range for this role is $33.75 to $66.25 per hour. 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.