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 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.If you reside in North Carolina, you will have the flexibility to work remotely as you take on some tough challenges.Primary Responsibilities:
Review of Musculoskeletal (MSK) care requests to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria
Review documentation submitted to support the medical necessity of the request
Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
Maintains contact with all parties involved in case necessary for case management for the client
Adheres to all documentation and performance guidelines
Assesses and interprets customer needs and requirements
Identifies solutions to nonstandard requests and problems
Works with minimal guidance; seeks guidance on only the most complex tasks
Schedule: 8:00am - 4:30pm OR 8:30am - 5:00pm EST, Monday - Friday.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 and active unrestricted (RN) Nursing License in North Carolina
3+ years of Nursing experience
1+ years of experience working as a Nurse in area of Musculoskeletal nursing or Prior-Authorizations.
Knowledge of the clinical criteria (e.g. CMS, InterQual, MCG, etc.).
Proficiency in operating computers applications
Access to high speed internet (Broadband Cable, DSL or Fiber) from home
Dedicated work space from home
Reside in North Carolina
Preferred Qualifications:
2+ years of Prior Authorization experience
2+ years of Musculoskeletal experience as a main part of your job
Managed Care experience
Proven excellent interpersonal skills
Proven excellent verbal and written communications skills
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyAt 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.