Preservice Review Nurse RN Telecommute

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm)

This position is for a Clinical Nurse working in the Prior Authorization and Appeals unit of OptumRx, a UnitedHealth Group company. The nurse’s primary role is reviewing Prior Authorization and Appeals cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and dynamic environment. On occasion, may need to make outbound calls to get clarification for the case.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Work is computer based and includes receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
• Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
• Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
• Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
• Organize workload, set priorities, complete assignments in a timely manner and utilize resources appropriately while complying with department program standards
• Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
• Conform with and supports department quality assurance and improvement guidelines
• Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of OptumRx
• Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team

*Shift after training will be an 8-hour shift with a 30-minute lunch. Candidate must be available as early as 5am local time and as late as midnight local time.

Candidate will work 5 days a week which may or may not include a weekend day(s). There is scheduled Overtime and working on Holidays. Dependent on business needs, candidate could work up to 4 hours a day of overtime.

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/Active, unrestricted RN license in your state of residence
• 2+ years of clinical experience in a hospital, acute care, home health / hospice, direct care or case management
• Solid knowledge of drug classes, dosages, and usage
• Solid computer skills, navigation, and quickly learn and adapt to new technology
• Adept with Microsoft Outlook, Microsoft Office (WORD, EXCEL) basic computer skills, and web based navigation
• Knowledgeable/adept with medical terminology and diagnosis
• Ability to make independent decisions to complete case reviews
• Ability to interpret medical guidelines and drug compendia
• Capable to apply and conduct a logical approach to case review and to arrive at fact-based recommendations based on source of truth documentation
• Excellent communication skills (verbal and written) via phone, in person, and e-mail in a professional and friendly manner
• Ability to communicate technical information to non-technical personnel
• Self-motivated, flexible person who can flourish in an office setting with colleagues as well as in a self-structured independent setting
• Ability to accept constructive feedback for continual improvement
• Thrives in a process based transactional work environment
• Ability to remain a neutral party, negotiate, and drive to expected result
• Has a passion for quality and performance improvement
• Able to work independently; self-motivated with good organizational and interpersonal skills
• Proven customer service skills and experience
• Excellent attendance

Preferred Qualifications:

• Bachelor of Science Nursing degree
• Previous PBM Experience, Healthcare/Health Insurance experience
• 1+ years in a Clinical Contact Center environment

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, 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 OptumRx. We’re one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You’ll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There’s no better place to help people live healthier lives while doing your life’s best work.(sm)

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

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $26.15 to $46.63. The hourly range for Connecticut/Nevada residents is $28.85 to $51.30. 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.

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.