LVN, Prior Authorization Nurse - Remote

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. If you are located in CA, you'll enjoy the flexibility to work remotely *as you take on some tough challenges. Primary Responsibilities: • Reviews patient referrals within the specified utilization management policy and regulatory compliance timeframes, manages production and ensures services to our providers and patients in a timely manner. (Type and Timeline Policy) • Performs all functions of an UM Prior Authorizations Nurse. • Consistently exhibits behavior and communication skills that demonstrate OPTUM's commitment to superior customer service, including quality, care and concern with each and every internal and external customer. • Implements current policies and procedures, standardization requirements set by the Utilization Management and by the UM Compliance department. • Implements and maintains regulatory turnaround times. • Responsible for implementing accuracy and accountability of the information provided when prepping prior authorizations requests for medical necessity and redirection within primary network with CMS. MediCal and health plan appropriate guidelines. • Assures that they utilize Standard Documentation when prepping referrals for processing. • Communicates authorization or denial of services to appropriate parties. Communication may include patient (or agent), referring physician, and Optum claims as necessary. • Demonstrates a thorough understanding of the cost consequences resulting from utilization management decisions through utilization of appropriate reports such as Health Plan Eligibility and Benefits, Division of Responsibility (DOFR) • Ensures appropriate utilization of medical facilities and services within the parameters of the patients' benefits and/or CMC decisions. • Maintains effective communication with the health plans, physicians, hospitals, patients. • Meets or exceeds all productivity standards set by your manager. • Maintains accurate and complete documentation of care rendered including POS, CPT Code, ICD-10, referral type, date, etc. • Completes and passes IRR (Interrater Reliability) at prescribed intervals per Management. • Attends all educational webinars and/or views on the SharePoint , and takes knowledge checks as per Management and UM Education direction. • Uses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. • Performs additional 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: • Graduation from an accredited school of Nursing • Current California LVN license • 3+ years of clinical experience • 1+ years of recent clinical experience. Preferred Qualifications: • 3+ years of recent clinical nursing experience • Prospective utilization review management applying CMS and health plan criteria for appropriate decision making • Managed care experience • All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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: 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 Apply Job!