Experience Inc. Jobs

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Position in this function is responsible for activities associated with retrospective claims reviews. Follows all retro review processes and meets all regulatory requirements. Consistently exhibits behavior and communication skills demonstrating Optum’s superior customer service, including quality, care, and concern with every internal and external customer.

If you are located within California or PST time zone and have California nurse license, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Performing a retrospective review of claims received for care and services in both the inpatient and outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients’ health plan benefits

• Conducts clinical reviews utilizing basic nursing knowledge, experience, and skills, as well as various managed care guidelines and departmental policy and procedures to ensure appropriate utilization of resources and patient quality outcomes

• Collaborates with care management and utilization management teams to ensure timely awareness of any process updates or changes occur routinely

• Ensures productivity targets, turnaround times are met

• Exhibits behavior and communication skills that demonstrate commitment to superior patient care, patient experience and patient outcomes

• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

• Attends all departmental meetings and huddles as assigned

• Reports/communicates findings to the Claims department Manager / Physician Reviewer / or department VP in a timely manner

• 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:

• Undergraduate degree or equivalent experience

• Unrestricted LVN/LPN license in the state of California

• 1+ years of recent clinical experience working as an LVN/LPN

Preferred Qualifications:

• Care management, utilization review or discharge planning, claims reviewer experience

• Computer literate

• Proven ability to work with multiple computer platforms simultaneous

• Proven ability to make sound, independent judgments, and act professionally under pressure

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 4, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

*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: 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.