Preservice Review Nurse LPN

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

The Field Nurse (LPN/LVN) conducts in-home/field-based visits to address urgent clinical issues with Landmark/Optum patients. While on-site, the Field Nurse will evaluate patients and communicate, via telephone or secure video, with the supervising provider. The provider will direct the evaluation and care provided. All activities will fall within the employee's scope of practice as set by the State they are practicing in.

Hours: Monday-Friday 8am-5pm in their time zones they reside

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

Primary Responsibilities:

Research member benefits and eligibility
Completes all assigned cases within required timeframes (TAT)
Processes and documents all case activities per SOPs and DES
Prepares and documents clinical case review and assigns to Medical Director for Medical Director (LTAC, AIR and SNF) decision
Communicates and documents Medical Director determinations to providers and members.
Maintains communications with providers for continuity of care and completion of ALOC requests
Prepares case information for assignment to National Letter Team
Submits requested Contract Exceptions for SNF cases
Educates providers, members and internal staff on guidelines, member benefits, alternate levels of care available
Acts as a clinical resource to non-Clinical staff
Collaborates with other internal stakeholder's/departments for member's appropriate level of care: Medical Director, Optum/United Nursing Home members, Appeals and Grievances, National Letter team, and Intake/CDU
Performs self-audits to assure compliance with SOP DES
Works within HSR, InterQual and, multiple SharePoint sites
Participates in compliance meetings, process improvement planning
Reports individual case concerns to manager, Medical Director as needed
Triage cases received from IPC
Assign cases to Facility ICM or other work groups

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:

High School Diploma/GED (or higher)
Current, unrestricted LVN/LPN license in the state you reside
3+ years of experience in Case Management
Intermediate level of proficiency with Microsoft Excel including the ability to quickly learn Clinical Applications

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged, and high-performing teams to help solve important challenges.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, Washington or New York City residents is $18.80 to $36.78. 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.

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