Weekday Optum Utilization Review Jobs in Chicago, IL

Remote, USA

Full time

R260000003079

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

The R1 Physician Advisory Solutions (PAS) team offers a range of services that help navigate the path to compliant revenue. The Admission Status Review (ASR) team of physician advisors within PAS proactively reviews cases concurrently and post-discharge to ensure compliant admission status, which increases compliance and reduces the risk of exposure to denials.

Responsibilities:

• Addresses the following issues: compliance and admission status.

• Review and respond to the customer in a timely manner; usually within 1-2 hours of the submission to the queue.

• Must work during pre-scheduled hours to be high successful in this role (schedules are created about 30 days in advance).

• Physicians should be highly capable of working independently with a high level of performance in in a rapidly changing, fast paced environment.

• Successful physicians will need to meet quality and productivity standards.

• Actively engage with attending physicians to discuss appropriate status as supported by documentation.

• Make phone contact with utilization review team and/or case managers at client hospitals regarding submitted case determinations.

• Provide written analysis of the case and perform case reviews across multiple specialties.

Required Qualifications:

• Active, unrestricted U.S. MD or DO medical licensure.

• At least 3 years of experience post-residency completion, focused on treatment of inpatients.

• Strong clinical knowledge base across multiple clinical areas.

• Computer proficient.

• Strong verbal and written communication skills.

• Professional, organized and possess persuasive writing and speaking skills.

• Possess strong negotiating/reasoning/logic and problem-solving skills.

• Must have flexibility with schedule to meet business need.

• Schedules may vary based on business need with the majority of business need late afternoon and evenings on weekdays, and mid-day to evenings on weekends

• Weekend work commitment required to include 30% or more of hours on the weekend to include Friday at 7pm through Sunday at midnight EST based on business needs.

• Ability to work as part of a team.

• Home office that is HIPAA compliant.

Desired Qualifications:

• Current Board Certification

• Previous experience with utilization review or chart review

For this US-based position, the base pay range is $150,075.00 - $199,070.29 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

This job is eligible to participate in our annual bonus plan at a target of 10.00%

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package. (http://go.r1rcm.com/benefits)

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)

To learn more, visit: R1RCM.com

Visit us on Facebook (https://www.facebook.com/R1RCM)

R1 is the leader in healthcare revenue management, helping providers achieve new levels of performance through smart orchestration. A pioneer in the industry, R1 created the first Healthcare Revenue Operating System: a modular, intelligent platform that integrates automation, AI, and human expertise to strengthen the entire revenue cycle. With more than 20 years of experience, R1 partners with 1,000 providers, including 95 of the top 100 U.S. health systems, and handles over 270 million payer transactions annually. This scale provides unmatched operational insight to help healthcare organizations unlock greater long-term value. To learn more, visit: https://www.r1rcm.com .