Preservice Review Nurse RN

Join Our Team at Optum

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 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 role are responsible for Women's Health/ Gender Dysphoria/ Genetics clinical reviews and require a current, unrestricted RN nursing license in the applicable state. Individual is responsible for performing pre-service clinical coverage review of outpatient Women's Health/ Gender Dysphoria/ Genetics services which require notification or requested pre-determination, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria.

If you reside in TN, you will have the flexibility to work remotely as you take on some tough challenges.

• Perform clinical reviews, which require decision making related to interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
• Ability to make appropriate clinical decisions within a business environment
• Serve as a member of a team with specific individual and team performance metrics
• Communicate in writing and verbally, all forms of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations
• Work independently and collaboratively with Medical Directors and other business partners
• Flexibility to adapt to changing environment and varied case volume
• Other duties as assigned by leadership

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.

• Active, unrestricted Registered Nurse license through the State of Tennessee
• 3+ years of RN patient care experience
• Proficiency working with Microsoft Office Products including Microsoft Outlook, Microsoft Word, and Microsoft Excel
• Reside in Tennessee

• Bachelor's degree
• Background involving utilization review or experience in case management, or previous experience with clinical claim review
• Familiarity with utilizing clinical guidelines (i.e.; Medicare, state, MCG or Inter Qual)
• Proven solid clinical judgement while applying medical necessity based on approved clinical resources

* All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $29.00 - $52.00 per hour based on full-time employment.

We comply with all minimum wage laws as applicable.

At United Health 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. United Health Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

United Health Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.