We're seeking a highly skilled and dedicated Central Denials Utilization Management Licensed Vocational Nurse (LVN) to join our team in California. As a remote worker, you'll enjoy the flexibility and freedom to work from the comfort of your own home, while making a meaningful impact on the lives of our patients. In this role, you'll play a critical part in ensuring the integrity of our adverse determination processes and the accuracy of clinical decision-making, driving success and excellence in healthcare.
At Optum, we're committed to redefining healthcare with a focus on health equity, affordability, quality, and convenience. Our Pacific West region is dedicated to helping over 2.5 million patients live healthier lives, and we're looking for talented individuals like you to join our team. As a Central Denials UM LVN, you'll be responsible for composing denial letters, evaluating out-of-network and tertiary denials, and collaborating with our medical director and UM compliance team to ensure compliance with established guidelines.
Your primary responsibilities will include:
- Consistently demonstrating superior customer service skills and behavior
- Performing all functions of a UM nurse reviewer, including composing denial letters and evaluating denials
- Ensuring the accuracy and compliance of denial notices with federal regulations, state regulations, health plan requirements, and NCQA standards
- Collaborating with our medical director and UM compliance team to ensure compliance with established guidelines
- Identifying gaps in training or process impacting the overall compliance of adverse determinations and communicating effective performance improvement solutions
- Meeting or exceeding productivity targets and using, protecting, and disclosing Optum patients' protected health information (PHI) in accordance with HIPAA standards
To be successful in this role, you'll need:
- Graduation from an accredited Licensed Vocational Nurse program
- Current LVN license in California
- 1 year of experience as a UM nurse reviewer and 1 year of recent clinical experience working as an LVN/LPN
- Computer literacy, proficiency in Microsoft Office Suite, and knowledge of utilization management platforms
- Proven critical thinking and problem-solving skills, with the ability to effectively communicate and collaborate with physicians, patients, families, and ancillary staff
We offer a competitive salary range of $19.47 to $38.08 per hour, comprehensive benefits, incentive and recognition programs, equity stock purchase, and 401k contribution. If you're passionate about delivering high-quality patient care and making a positive impact on the healthcare system, we encourage you to apply for this exciting opportunity.
At UnitedHealth Group, we're committed to diversity, equity, and inclusion, and we believe that everyone deserves the opportunity to live their healthiest life. We're 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.
Apply Now and join our team of dedicated healthcare professionals who are passionate about making a difference in the lives of our patients.
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