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.
- Remain up to date with the contract requirements
- Use clinical judgement to ensure a clear, comprehensive, and concise exam documentation that is reflective of the patient’s service level conditions and in compliance to contract requirements
- Interpret and document diagnostic test results
- Educate and support provider with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork
- Answer calls that come into the Clinical Operations Review queue regarding medical or specialty exams and provide exemplary service to providers with appointment questions
- Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high-risk intervention process
- Complete system generated tasks to process exam documentation
- Interface via telephone and e-mail with contracted providers in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol
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.
- Accredited Associate's Degree in Nursing (ADN) OR Bachelor’s Degree in Nursing (BSN)
- Current RN license in your state of residency
- 2+ years of experience in a clinical environment as a Registered Nurse
- Experience working in an Electronic Medical Record system
- Understanding/knowledge of regulatory standards and their application to various examinations and documents
- Proficient computer skills including Microsoft Office programs and database experience
- Ability to work 1:00pm to 10:00pm ET/12:00pm to 9:00pm CT/11:00am to 8:00pm MT/10:00am to 7:00pm PT
- Ability to work rotating weekends (approximately every 8 weeks)
- Distraction-free, dedicated space in home for home office
- Access to high-speed internet (cable, fiber optic)
- Experience in an Intensive Care Unit or Emergency Room
- Prior authorization, utilization management/review experience
- Experience reviewing Medical Disability claims
- Knowledge or experience in:
- Clinical quality assurance
- Auditing and compliance
- Education of clinical staff
- Clinical documentation improvement
- Clinical experience:
- Neurological
- Cardiovascular or Respiratory units
- ISO 9001 standards
- Healthcare regulatory and accreditation standards
- Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
- Military experience
- Proven ability to collaborate with providers to ensure quality patient outcomes
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.