Description
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 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.**
You're empowered to do your best by supporting Optum Government Solutions Massachusetts (MA) Long Term Services and Supports (LTSS) Third Party Administration (TPA) program. Supporting the Commonwealth of Massachusetts, the MALTSS TPA program manages several elements of MassHealth's LTSS program, including prior authorization, provider enrollment and credentialing, program integrity, and quality improvement. The **Preservice Review Nurse RN** is responsible for performing pre-service/prior authorization clinical coverage review of Home Health Services and Day Habilitation. Works closely with managers and peers.
If you live in the state of Massachusetts, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.
**Primary Responsibilities:**
Performing pre-service/prior authorization clinical coverage review of Home Health Services and Day Habilitation
Review/interpret clinical/medical records submitted from provider
Will be responsible in answering provider inquiries/encounters
Determine the appropriateness of community services following evaluation of medical guidelines and benefit determination
Identify solutions to non-standard requests and problems
Participates in regular meetings to collaborate with supporting leadership and team to ensure operational efficiency
Assures performance adheres with established quality standards, evidenced based practice guidelines and departmental benchmarks and workflows
Act as a resource for others; provide explanations and information on difficult issues
Represents the MA MLTSS program in a positive, solution focused manner that embodies our corporate values: Integrity, Compassion, Relationships, Innovation and Performance
Minimum 10% travel within the state of MA
**What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:**
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
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:**
Associate's Degree (or higher) in Nursing
Unrestricted RN license in the state of Massachusetts
3+ years of previous clinical and/or Prior Authorization Utilization Management experience
Designated workspace and access to install secure high-speed internet via cable or DSL in home
**Preferred Qualifications:**
Reside in the state of Massachusetts
Familiarity with Massachusetts Medicaid
Previous Day Habilitation experience
Previous Home Health Service experience
Proficient with Microsoft Office programs, including Word, Excel, PowerPoint
Excellent communications skills, including the ability to write clearly, succinctly and in a manner that appeals to a wide audience
Excellent time management, organizational, and prioritization skills with ability to balance multiple priorities
Able to work independently, self-directed and the ability to be self-starter
*All Telecommuters 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: 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.-
\#RPO #Green
Compensation Information:
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Starting At: 0.0
Up To: 0.0
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