The Critical Care Nurse in Optum will ensure defensible and accurate case recommendations for concurrent admission, continued to stay, and concurrent denial cases which are then reviewed by a Physician Advisor for completion of the concurrent and/or peer to peer review.
They will be working directly with the Physician Advisors utilizing the guidance provided in order to make defensible and accurate case recommendations.
Required Qualifications:
- Active Registered Nurse license
- Strong Clinical Knowledge base with a minimum of 2 years of Critical Care, ED or 5+ years of Med Surge experience in a non-university / nursing school setting
- Current clinical experience in a secondary or tertiary hospital (bed capacity of 100 or more) setting assigned in the following areas: (Emergency Department, Intensive Care Unit / Critical Care / Telemetry / Adult Medical Surgery Ward)
- Strong written and verbal communication skills
- Strong working knowledge and proficiency in Microsoft packages, Outlook, Word, and Excel
Preferred Qualifications:
- Abroad or BPO experience specifically clinical account for at least 1 year (e.g., preauthorization reviews, case management, appeals, denial management, clinical BPO etc.)
- Familiarity with the USA health systems and Electronic health records
- Preferably with a working internet connection of at least 15 mbps in case of working from home. The following options are also available:
- Corporate internet subsidy for those within available and valid serviceable locations, subject to Company Policy
- Onsite work for those who are amenable to drive or commute to our office locations
What We Offer:
- Market Competitive Pay Levels
- Retirement Plan
- Annual Performance-Based Merit Increases
- Medical Plan (HMO)
- Dental, Medical and Optical Reimbursements
- Life and Disability Insurance
- Tuition Reimbursement
- Paid Time-Off Benefits
- Sick Leave Conversion
- Employee Assistance Program (EAP)
- Recognition
- Training and Staff Development
- Employee Referral Program
- Employee Volunteerism Opportunity
Your role is critical in allowing our members, families, facilities and health professionals to have greater confidence in the exceptional care we provide. And for you, an everyday opportunity to do your life's best work.