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Remote Optum Rn Jobs in Reading, PA (NOW HIRING)

ConcertoCare

Field Nurse (LPN)

Reading, PA · Remote

$28 - $32/hr

Works with providers, market RNs, nurse case managers, social workers, pharmacists, community ... remote clinical practitioner. * Perform clinical procedures, including blood draws, laboratory ...

ZOLL Medical

Patient Service Representative

Pottstown, PA · Remote

$17 - $21.75/hr

Patient Service Representative (PSR) Remote independent contract worker position Competitive fee ... Preferred Candidates include (not limited to): RN, EMT, Paramedic, EMS, Firefighter, PA, LPN, MA ...

ZOLL Medical

Patient Service Representative

Reading, PA · Remote

$16.75 - $21.25/hr

Patient Service Representative (PSR) Remote independent contract worker position Competitive fee ... Preferred Candidates include (not limited to): RN, EMT, Paramedic, EMS, Firefighter, PA, LPN, MA ...

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All JobsRemote Optum Rn JobsRemote Optum Rn Jobs in Reading, PA

Remote Optum Rn information

What is the difference between Remote Optum Rn vs Remote UnitedHealth Group Rn?

AspectRemote Optum RnRemote UnitedHealth Group Rn
CredentialsRegistered Nurse (RN) license, applicable certificationsRegistered Nurse (RN) license, applicable certifications
Work EnvironmentRemote healthcare services, telehealth platformsRemote healthcare services, telehealth platforms
Employer & IndustryOptum, healthcare and health services industryUnitedHealth Group, healthcare and insurance industry

Both Remote Optum Rn and Remote UnitedHealth Group Rn roles involve providing remote nursing care within the healthcare industry. They require similar credentials and work environments, often utilizing telehealth platforms. The main difference lies in the employer and specific focus areas within the healthcare sector, with Optum focusing on health services and UnitedHealth Group encompassing broader health insurance and services.

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Remote Optum Rn jobs near you

Nurse Reviewer - Reading, PA

Healthcare Quality Strategies, Inc.

Reading, PA • Remote

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Posted 16 days ago

Job description

Nurse Reviewer
PT (20-30 hours week) – Remote Work Environment
Non-Exempt: $40.00 hour
Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely.
Essential Duties and Responsibilities:
  • Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies
  • Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines
  • Document evidence-based criteria applicable to specific contract requirements
  • Record and report screening results, including relevant referral questions, into a centralized database
  • Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity
  • Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations
  • Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards
Knowledge, Experience, Skills and Education:
  • Medical terminology, ICD-10, CPT and HCPCS
  • Clinical criteria (InterQual and MCG)
  • Utilization/Medical record review and chart abstraction
  • Current standards of medical practice
  • Comply with HIPAA/HITECH laws and regulations
Experience in:
  • At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred)
  • Experience performing medical record review, audit for federal or state contracts
  • Knowledge and experience of Medicare and Medicaid policy
  • Proficiency with Microsoft Office (Word, Excel, and Outlook)
  • Proficiency with Adobe PDF files and features
  • Generating accurate, timely, and understandable correspondence
  • Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG)
Skills Requirements include:
  • Professional interpersonal skills; ability to interact with providers, physicians and peers
  • Solid analytical, assessment and documentation skills
  • Effective written and verbal communication, both internally and externally
  • Strong attention to detail
  • Strong attention to deadlines
  • Organizational skills including effective time management, priority setting and process improvement
  • Ability to work independently and as a member of a team
  • Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations
Educational Background:
  • BSN with active RN licensure in good standing
Physical Demands:
Remote Work, Prolonged Sitting, Screen Exposure
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD amp;D, voluntary life/AD amp;D, 401k
For immediate consideration, please apply via the HQSI Careers Page at: www.hqsi.org gt; Careers gt; Current Employment Opportunities
EOE: Minorities/Females/Disabled/Veterans
Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace
Healthcare Quality Strategies, Inc. is an E-Verify Employer

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