Spine, Pain and Joint - SPJ - Prior Authorization RN - Remote

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.

We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Prior Authorization/Preservice Review RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today!

The Spine, Pain and Joint (SPJ) Prior Authorization RN has the clinical responsibility for the overall direction, utilization, supervision, instruction, and examination of the medical care of the member assigned to them.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Review of Spine, Pain and Joint (SPJ) care evaluations and progress reports to determine if medical necessity has been met or refer to Medical Directors when clinical information does not meet clinical criteria for either initial or continued authorization
• Review documentation submitted to support the medical necessity of the request
• Review hierarchy of applying medical policy and InterQual criteria and support state and federal requirements
• Ensure clinical information submitted for peer review and entered into patient’s electronic record is the most accurate and up to date
• Interacting with the physician to ensure the most appropriate and highest quality of care is recommended
• Collaborate with Contract Assistants working on their team to ensure that responses to authorization requests are responded to within Regulatory time frames
• Acts as clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to render a decision regarding procedure as well as effectively manage length of stay and utilization resources as appropriate
• Adheres to all documentation and performance guidelines
• Other duties as assigned

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, unrestricted RN license in state of residence
• 3+ years of hands-on clinical experience as a Registered Nurse in a clinical setting
• 1+ years of Prior Authorization/preservice review experience
• 1+ years of Musculoskeletal and/or Orthopedic experience
• Experience of Medicare pre-service review
• Demonstrated proficiency in computer skills including Microsoft Word, with the ability to navigate a Windows environment
• Proven solid written and verbal communication skills
• Demonstrated attention to detail, organizational skills and multitasking abilities will be keys to success
• Designated workspace and access to install secure high-speed Internet via cable/DSL in home

Preferred Qualifications:

• BSN
• Compact RN license
• Pain management experience
• CMS and/or InterQual experience

California, Colorado, Connecticut, Hawaii, 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 $28.03 to $54.95 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.

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.