Optum Job Opportunity
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 theyneed 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. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Research member benefits and eligibility
- Completes all assigned cases within required timeframes
- Processes and documents all case activities per SOPs and DES
- Prepares and documents clinical case review and assigns to Medical Director for Medical Director (LTAC, AIR and SNF) decision
- Approves SNF cases where RN's clinical review indicates that member's condition meets clinical criteria
- Approves SNF cases where an LPN's clinical review indicates that member's condition meets clinical criteria
- Communicates and documents Medical Director determinations to providers and members
- Maintains communications with providers for continuity of care and completion of ALOC requests
- Prepares case information for assignment to National Letter Team
- Submits requested Contract Exceptions for SNF cases
- Educates providers, members and internal staff on guidelines, member benefits, alternate levels of care available
- Acts as a clinical resource to LPNs, PTs, and Non-Clinical staff
- Collaborates with other internal stakeholders/departments for member's appropriate level of care
- Performs self-audits to assure compliance with SOP DES
- Works within HSR, InterQual, and multiple SharePoint sites
- Participates in compliance meetings, process improvement planning
- Reports individual case concerns to manager, Medical Director as needed
- Triage cases received from CAC
- Assign cases to Facility ICM or other work groups
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:
- High School Diploma / GED (or higher)
- RN license/certificate
- 3+ years of experience in Case Management, UM preferred
- Must be able to work in MST or PST time zone
- Weekend availability
- Dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Preferred Qualifications:
- Prior Authorization experience
- Case management certification and/or experience
- Experience in discharge planning and/or chart review
- Experience in acute long-term care, acute rehabilitation, or skilled nursing facilities
- Experience in utilization review for an insurance company or in a managed care environment
Soft Skills:
- Solid computer skills
- Solid communication skills and ability to build and maintain relationships
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). The hourly pay for this role will range from $34.23 to $61.15 per hour based on full-time employment.
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.