UnitedHealth Group

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

Outpatient RN Case Manager

Medical Billing and CodingMedical Billing and CodingFull TimeRemoteTeam 10,001

Location

United States

Posted

16 days ago

Salary

Not specified

No structured requirement data.

Job Description

Optum CA is seeking an Outpatient Case Manager to join our team in San Diego, CA. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. In this role, you will: Review contracted Medical Group’s authorization requests for medical necessity Determine which requests need Medical Director review Obtain sufficient medical documentation for informed decisions Process all requests within established timeframes Document all steps of the process in the authorization system Utilize industry standard denial language for denial letters The work schedule will be Monday through Thursday 6:30am-5pm. Primary Responsibilities: Review contracted Medical Group’s referral requests for medical necessity Consider appropriateness of the setting, place of service, health plan’s benefits, and criteria of the requested services Document process in authorization notes Refer all medical necessity denials to the physician for review Process denials within established timeframes Document denial reasons in the authorization system utilizing industry standard denial letter language Outline alternative services available Review requests within established timeframes for urgent, routine, and retro requests to maintain compliance with legislative and accreditation standards Obtain additional information for review of appeals Coordinate with health plan to meet timeframes for expedited appeals 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.

Job Requirements

  • Graduation from an accredited school of nursing
  • Active, unrestricted Registered Nurse license through the State of California
  • 1+ years of experience in case management or utilization review experience in a clinical setting
  • Proficient with computers and Microsoft Windows environment
  • Reside in the San Diego, CA area
  • Bachelor of Science in Nursing, BSN (preferred)
  • 3+ years of experience working in acute care (preferred)
  • HMO experience (preferred)

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution (all benefits are subject to eligibility requirements)
  • The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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