Preservice Review Nurse LPN PST - Remote - 2203587
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 to start Caring. Connecting. Growing together.
Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.
This position is full-time (40 hours/week). Employees are required to have flexibility to work any shift schedules during normal business hours in the Mountain or Pacific time zones, to include weekend coverage.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must be willing to work 8am – 5pm PST
- Understand and follow standardized processes for managing add or change requests and implementing requests in the letter generation system
- Create and review denial letters to determine compliance with contractual and regulatory requirements of the State and Federal programs, while reviewing for efficiencies and effectiveness of procedures
- Performs internal Quality Control reviews on processes and activities regarding letter writing
- Identify and correct letter deficiencies
- Work independently or in a team environment
- Demonstrate high attention to detail, exceptional documentation abilities, and organizational skills
- Collaborate with our business partners, Letter Owners, and other Letter Maintenance Administrators (LMA’s) regarding letter template design and development
- Develop new templates and / or change templates for approved letter requests
- Promote tested letter templates to production
- Analyze inventory and identify opportunities to streamline, decommission, combine, etc.
- Summarize results / recommendations and present findings to supervisor
- Other duties as assigned by supervisor which fall into the scope of practice
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.
- LPN nurse (current and unrestricted) – compact state license, able to obtain endorsement licensures for other states as needed
- 1+ years of direct clinical patient care
- Knowledge of managed care principles
- Knowledge of medical terminology
- Proven solid interpersonal, oral, and written communication skills
- Proven basic computer skills
- Proven excellent written skills – grammar and punctuation
- Proven detail oriented
- Proven comfortable working with medical directors
- 3+ years of direct clinical patient care
- 1+ years of experience with medical management activities in a managed care environment
California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $18.80 to $36.78 per hour. 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 employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.