Submission for the position: Oncology Preservice Review Nurse RN - Telecommute - (Job Number: 944915)
Oncology Preservice Review Nurse RN - Telecommute
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
We’re making a strong connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that’s driving the health care industry forward. As a Telephonic Oncology Preservice Review Nurse you will be performing pre-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Determines medical appropriateness of outpatient services following evaluation of medical guidelines and benefit determination. Ready for a new path? Apply today!
This position is work at home. Work schedule expectations offer some flexibility with a combination of day and consumer hours. Some evening and weekend hours will be required.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
• Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial)
• Validate that cases/requests for services require additional research
• Identify and utilize appropriate resources to conduct non-clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources)
• Prioritize cases based on appropriate criteria (e.g., date of service, urgent, expedited)
• Ensure compliance with applicable federal/state requirements and mandates (e.g., turnaround times, medical necessity)
• Review/interpret clinical/medical records submitted from provider (e.g., office records, test results, prior operative reports)
• Identify missing information from clinical/medical documentation, and request additional medical or clinical documentation as needed (e.g., LOI process, phone/fax)
• Review and validate diagnostic/procedure/service codes to ensure their relevance and accuracy, as applicable (e.g., PNL list, EPAL list, state grid, LCDs, NCDs)
• Identify and validate usage of non-standard codes, as necessary (e.g., generic codes)
• Apply understanding of medical terminology and disease processes to interpret medical/clinical records
• Make determinations per relevant protocols, as appropriate (e.g., approval, denial process, conduct further clinical or non-clinical research)
• Review care coordinator assessments and clinical notes, as appropriate
• Identify relevant information needed to make medical or clinical determinations
• Identify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG, medical
This position will require active and unrestricted Nursing licensure in multiple US States. Selected candidate must be willing and able to obtain and maintain multiple state licensure (Application fees and filing costs paid for by UHG).
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:
• Current, unrestricted RN license in the state of residence
• Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses
• 3 years of Oncology experience as a Nurse in a Hospital setting, Acute Care, Direct Care experience or experience a Telephonic Case Manager/Utilization Preservice for an insurance company
• Computer proficiency, to include strong data entry skills and the ability to navigate a Windows environment
• Access to high speed internet from home (Broadband cable, Fiber or DSL)
• Dedicated workspace for home office set up
• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
Preferred Qualifications:
• BSN
• OCN Certification
• Chemo/Bio Certification
• Certified Case Manager (CCM)
• Background in preservice review/utilization review/utilization management
• Chemo infusion experience
• ICD Coding experience or strong knowledge of codes
• NCCN experience
• Medicaid, Medicare, Managed Care experience
• Background in managed care
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Colorado Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Job Keywords: Infusion Nurse, Chemotherapy Infusion Nurse, Oncology Nurse, Nurse Navigator, Oncology Nurse Navigator, Oncology, Cancer, Case Manager, Care Coordinator, Utilization Management, Utilization Review, RN, Nurse, Chemotherapy, Infusion, Specialty Medication, National Comprehensive Cancer Network, NCCN, OCN, CCM, Telecommute, Virtual, Work From Home, Houston, TX, Texas, Tampa, FL, Florida, Atlanta, GA, Georgia, Greensboro, NC, North Carolina, Orlando, St Louis, MO, Missouri
Clin Coverage Rvw/Prior Author
US-FL-Tampa
US-MO-Saint Louis, US-GA-Atlanta, US-AZ-Phoenix, US-TX-Houston, US-NC-Greensboro
ECS-MBM Ops CMC
Jul 27, 2021, 12:56:59 PM
Schedule: Full-time Location(s): US-FL-Tampa