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The Preservice Nurse (LPN/LVN) will collaborate with medical directors, nurses and clinical coordinators and communicate, via telephone or secure video, with the supervising provider. The provider will direct the evaluation and care provided. You will work out of a queue and generate letters based on the specific need. 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

If you are located in either Pacific Standard or Mountain Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Researches 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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Nevada, or Washington Residents Only: The hourly range for this role is $19.47 to $38.08 per hour. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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