Preservice Review Nurse RN - Remote in CST or MST Time Zones
Preservice Review Nurse RN - Remote in CST or MST Time Zones — remote position open now. Apply today.
Remote Preservice Review Nurse RN - Remote in CST or MST Time Zones. full time. Open to candidates in Remote. Apply now.
About the Role
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'll 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.
Positions in this family require a current, unrestricted nursing license (i.e. RN) in the applicable state, as indicated in the function description and/or job title.
Positions in this function require various nurse licensure and certification based on role and grade level. Licensure includes RN, depending on grade level, with current unrestricted licensure in applicable state.
If you are located in CST or MST Time Zones, your role involves have the flexibility to work remotely* as you take on some tough challenges.
General Position Profile:
You\'ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Key Responsibilities
- Make determinations per relevant protocols, as appropriate (e.g., approval, denial process, conduct further clinical or non-clinical research)
- Serves as a resource to others
- Collaborate with applicable internal stakeholders as needed to drive the clinical coverage review process (e.g., Medical Directors and their staff, Optum, UHC, Account Management)
- CPS_Make Final Determinations Based on Clinical and Departmental Guidelines Demonstrate understanding of business implications of clinical decisions to drive high quality of care
- CPS_Conduct Clinical Research to Support Determinations Identify relevant information needed to make medical or clinical determinations
- CPS_Achieve and Maintain Established Productivity and Quality Goals Meet/exceed established productivity goals
- Works with less structured, more complex issues
- Open to required weekend rotation schedule in the future
- Acts as a resource for others with less experience
- Identify and consider appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalate to ensure optimal outcomes, as needed
- Review/interpret clinical/medical records submitted from provider (e.g., office records, test results, prior operative reports) -Identify missing information from clinical/medical documentation, and request additional medical or clinical documentation as needed (e.g., LOI process, phone/fax)
- Flexible with work hours - hours/days can change as needed for the business
Frequently Asked Questions
Is this Preservice Review Nurse RN - Remote in CST or MST Time Zones role remote?
Yes — 100% remote. Work from anywhere in Remote.
Employment type for this Preservice Review Nurse RN - Remote in CST or MST Time Zones job?
full time. Ideal for remote professionals.
How to apply?
Click Apply Now above. Rolling interviews.
Submit your application today — this won't stay open long.