HCBS Utilization Management Nurse Specialist

6 days ago


Washington, Washington, D.C., United States Optum Full time

About Optum

">

Optum is a leading healthcare company dedicated to improving the lives of millions of people around the world. Our mission is to help people live healthier lives and make the health system work better for everyone.

We believe that everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. 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.

To address these disparities, we are committed to mitigating our impact on the environment and enabling and delivering equitable care that improves health outcomes. This includes promoting diversity, equity, and inclusion in all aspects of our business, from hiring and talent development to community engagement and philanthropy.

Salary Range

The salary range for this role is $58,300 to $114,300 annually, based on various factors such as local labor markets, education, work experience, certifications, and more.

Job Description

This is an exciting opportunity to join our team as a HCBS Utilization Management Nurse Specialist In this role, you will be responsible for performing pre-service clinical coverage reviews of Private Duty Nursing (PDN) and Personal Care Services (PCS). You will use applicable benefit plan documents, evidence-based medical policy, and nationally recognized clinical guidelines and criteria to determine medical appropriateness of HCBS services.

You will also work closely with external and internal business partners, including UnitedHealthcare clinical services, intake/prior authorizations, appeals and grievance, quality, case and disease management, behavioral health, and other clinical specialties. Additionally, you will engage with the National Letter Team to complete mailing of member and provider notifications of decisions.

Responsibilities



  • Washington, Washington, D.C., United States Specialist Office Full time

    Job SummaryWe are seeking a highly skilled Medical Receptionist to join our team at Specialist Office in Washington DC. This is an excellent opportunity for an experienced professional to utilize their expertise in medical administration and provide exceptional patient care.About the RoleThis Medical Receptionist position will be responsible for ensuring...


  • Washington, Washington, D.C., United States Prisma Health Full time

    Job SummaryThis position provides in-depth analysis and expertise in coding and utilization review for Homecare patients and clinical staff. A key aspect of this role is to identify areas of improvement and optimize resource allocation to ensure accurate reimbursement.Key ResponsibilitiesDevelop and deliver coding education programs for clinical and...


  • Washington, Washington, D.C., United States DispatchHealth Management Full time

    We are seeking a highly skilled Digital Imaging Specialist to join our team at DispatchHealth Management. As a Diagnostic Imaging Specialist, you will have the opportunity to work with cutting-edge technology and provide top-notch patient care in various settings.About the Role:This full-time position offers a competitive salary of $60,000 - $80,000 per...


  • Washington, Washington, D.C., United States Medstar Full time

    Job OverviewWe are seeking a highly skilled Utilization Review Specialist to join our team at Medstar. In this role, you will play a crucial part in ensuring high-quality patient care by conducting thorough reviews of medical records.


  • Washington, Washington, D.C., United States Olive Tree Management Full time

    Job DescriptionOlive Tree Management is seeking a motivated and experienced Property Management Specialist to join our team. As a key member of our property management department, you will be responsible for marketing and leasing properties, ensuring they are maintained effectively and efficiently.About the RoleWe are looking for an enthusiastic and...


  • Washington, Washington, D.C., United States Nurse First Full time

    We are seeking a skilled Diagnostic Imaging Specialist to join our team on a 13-week contract in South Carolina. This exciting opportunity will allow you to utilize your expertise in medical imaging and work with a dynamic team of healthcare professionals.About the RoleThis contract position offers the chance to work as a CT Technologist, providing...


  • Washington, Washington, D.C., United States Nurse First Full time

    Nurse First is seeking a travel Diagnostic Imaging Specialist for a challenging opportunity in the United States.About Nurse FirstWe are committed to providing our travel nurses with the best experience possible. Our company's founder was a nurse, and at our roots, we believe nurses need advocates to help them have the best experience possible.Our travel...


  • Washington, Washington, D.C., United States FOXXSTEM Full time

    Job OverviewAt FOXXSTEM, we are seeking a skilled Water Utility Specialist to join our team in the Washington, DC area. As a key member of our construction team, you will be responsible for ensuring the quality and integrity of water and wastewater treatment projects.


  • Washington, Washington, D.C., United States nTech Workforce Full time

    Job SummarynTech Workforce is seeking a results-driven Utility Program Manager to oversee various electric utility distribution programs and projects.The salary for this position is approximately $90,000 per year, commensurate with experience.About the Position:This is a leadership role that requires strategic thinking and problem-solving skills.The ideal...


  • Washington, Washington, D.C., United States Odle Management Full time

    The Educational Assessment Specialist will play a pivotal role in preparing young people for the workforce by administering adult basic education tests (TABE) to students. This salaried, exempt position reports to the Academic Manager and is responsible for determining students\' initial, interim, and final reading and math performance achievement levels and...


  • Washington, Washington, D.C., United States DispatchHealth Management Full time

    Company OverviewDispatchHealth Management is a leading provider of in-home care services, delivering trusted and compassionate care to patients nationwide. Our teams of emergency medicine and internal medicine trained medical professionals are equipped to treat common to complex injuries and illnesses in the comfort of patients' own homes.About the RoleWe...


  • Washington, Washington, D.C., United States DispatchHealth Management Full time

    About DispatchHealth ManagementDispatchHealth Management is a leading provider of in-home care services, dedicated to delivering trusted and compassionate care to individuals of all ages. Our team of emergency medicine and internal medicine trained medical professionals is equipped with state-of-the-art equipment to treat common to complex injuries and...


  • Washington, Washington, D.C., United States District Elite Pest Management Full time

    Pest Management ProfessionalAt District Elite Pest Management, we are seeking a highly skilled and detail-oriented Pest Control Specialist to join our team in Washington, DC, and surrounding areas. With trust and integrity as core values of our company, we strive to provide comprehensive pest control services that meet the highest standards.As a Pest Control...


  • Washington, Washington, D.C., United States Cynet Health Full time

    About the JobCynet Health seeks a skilled ICU Nurse Specialist to join their team. This 13-week assignment offers a unique opportunity to work in a fast-paced, dynamic environment and utilize your expertise in critical care.Job SummaryWe are looking for a compassionate and dedicated Registered Nurse (RN) with experience in Intensive Care Unit (ICU) settings....


  • Washington, Washington, D.C., United States DispatchHealth Management Full time

    About the RoleAs a Diagnostic Echocardiographer Specialist at DispatchHealth Management, you will play a critical role in delivering high-quality patient care through the performance of mobile echocardiographic scans using portable equipment. This position requires strong technical knowledge and skills, as well as excellent communication and interpersonal...


  • Washington, Washington, D.C., United States DispatchHealth Management Full time

    Company OverviewDispatchHealth Management is a leading provider of mobile healthcare services, revolutionizing the way patients receive medical care. With a focus on delivering high-quality, compassionate care to all communities, we are committed to transforming the healthcare landscape through innovation and personalized service.Salary: $100,000 - $140,000...


  • Washington, Washington, D.C., United States TechFlow, Inc. Full time

    About the RoleThis Part Time Utility Cleaner Specialist position is available at TechFlow, Inc. in a Joint Base Anacostia-Bolling setting. The successful candidate will be responsible for maintaining the cleanliness of communal spaces, restrooms, workspaces, and outside areas as assigned.The ideal candidate will have prior experience in custodial roles,...


  • Washington, Washington, D.C., United States Medical Solutions Full time

    We are seeking a talented travel nurse RN with expertise in utilization review to join our team at Medical Solutions. As a travel nursing professional, you will have the opportunity to work with top healthcare systems and organizations across the country.Estimated Salary Range: $145,000 - $175,000 per yearJob Description:As a travel nurse RN case manager for...


  • Washington, Washington, D.C., United States Travel Nurse Across America Full time

    We are seeking a skilled Telemedicine Nursing Specialist to join our team at Travel Nurse Across America. This is an exciting opportunity for a dedicated RN to provide high-quality patient care in Washington, DC.Job Summary:As a Telemedicine Nursing Specialist, you will be responsible for monitoring patients' vital signs and providing appropriate care based...


  • Washington, Washington, D.C., United States Nurse First Full time

    Nurse First is seeking a highly skilled Mobile Imaging Specialist for a travel opportunity in Columbia, South Carolina.About the JobAs a Mobile Imaging Specialist, you will be responsible for operating imaging equipment to produce high-quality diagnostic images. Your expertise and professionalism will make a significant impact on patient care.Key...