HCBS Utilization Management Nurse Specialist
6 days ago
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.
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