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Medical Management Nurse

1 month ago

Annandale, Virginia, United States Optum Full time
Job Title: Nurse Medical Management

Join our team of healthcare professionals as a Nurse Medical Management specialist, where you will play a critical role in ensuring the delivery of high-quality, cost-effective healthcare services.

Job Summary:

We are seeking a highly skilled and experienced Nurse Medical Management professional to join our team. As a key member of our Utilization Management department, you will be responsible for reviewing and authorizing healthcare services to ensure they meet the medical necessity and appropriateness criteria.

Key Responsibilities:
  • Conduct thorough reviews of medical records and clinical information to determine medical necessity and appropriateness of healthcare services
  • Collaborate with healthcare providers, case managers, and other stakeholders to ensure seamless care coordination
  • Develop and implement clinical guidelines and policies to ensure consistency and quality of care
  • Participate in quality improvement initiatives to identify areas for improvement and implement changes
  • Stay up-to-date with the latest clinical research, guidelines, and regulations to ensure compliance and best practices
Requirements:
  • 2+ years of clinical experience in healthcare settings
  • Experience in utilization management, case management, or a related field
  • Strong knowledge of clinical guidelines, policies, and regulations
  • Excellent communication and interpersonal skills
  • Ability to work in a fast-paced environment and prioritize multiple tasks
What We Offer:

At Optum, we offer a comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) plan and employee stock purchase program. We also offer opportunities for professional growth and development, as well as a dynamic and supportive work environment.