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Utilization Management LPN - Massachusetts Telecommute

UnitedHealth Group

Boston, MA
Job Code:
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Job Details

744086 Utilization Management LPN Massachusetts Telecommute

Utilization Management LPN - Massachusetts Telecommute (744086)

Position Description

Position Description:
You dream of a great career with a great company - where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation and Performance.
There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.
***This is a telecommuter position, but it does require that the individual live close to one of the offices in the Boston area. ***
Primary Responsibilities:
  • Responsible for performing prior authorization review of services that require notification, using applicable benefit plan documents, evidence-
  • based medical policy and state specific recognized clinical guidelines and criteria
  • Determines medical appropriateness of provider services following evaluation of medical guidelines and benefit determination
  • Interacts with providers to obtain clinical information to support prior authorization determinations and provide support for their questions
  • Evaluate applicability of community resources/government programs / LTSS provider services to member needs
  • Navigate relevant computer systems to identify internal and external resources
  • Perform / support clinical appeals (e.g., notes, previous reviews, obtain rationales) LPN
Required Qualifications:
  • High School Diploma / GED
  • Unrestricted LPN License in the State of MA
  • 5+ years of experience in clinical nursing, PA / UM or working with individuals receiving LTSS services
  • Ability to interpret benefits and /or clinical / LTSS guidelines
  • Ability to create, edit, save and send documents utilizing Microsoft Word and ability to navigate a Windows environment
Preferred Qualifications:
  • Prior authorization experience
  • Utilization Management experience
  • Chart Review
  • Case Management experience
  • Certified Case Manager (CCM)
  • Medicaid Experience
  • Experience working with the LTSS population
  • Managed Care Experience
Soft Skills:
  • Ability to collaborate with stakeholders
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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.
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. 
Keywords: registered nurse, RN, case manager, UM, UR, PA, prior authorization, pre-authorization, utilization management, Utilization review, chart review, quality review, Milliman, CCM, LTSS, long term care, managed care, Medicaid, Waltham, Avon, Needham and Wakefield, MA, Massachusetts

Job Details

  • Contest Number744086
  • Job TitleUtilization Management LPN - Massachusetts Telecommute
  • Job FamilyNursing
  • Business SegmentOptum Government Solutions

Job Location Information

  • Boston, MA
    United States
    North America
  • Other LocationsSpringfield, MA

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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