Preservice Review Nurse RN

Caring. Connecting. Growing Together.

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. Join us to start making an impact on the communities we serve as you help us advance health equity on a global scale.

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. Works closely with managers and peers.

If you currently reside in the state of Massachusetts, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Determine the appropriateness of inpatient and outpatient 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

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 required in state of Massachusetts
• 3+ years of Managed Care and/or clinical experience
• Reside in the state of Massachusetts
• Designated workspace and access to install secure high-speed internet via cable or DSL in home

Preferred Qualifications:

• Prior-Authorization experience
• Utilization Management experience
• Home Health Agency experience
• Medicare/Medicaid experience preferred
• 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

*All Telecommuters will be required to adhere to UnitedHealth 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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.