Career Center

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Under the general direction of the Director of UM, UM Administrative Manager, and the Prior Authorization LVN Supervisor, the Prior Authorization LVN ensures that prior authorization requests from patients and providers are completed in a timely fashion to meet the contractual and regulatory requirements while acting within the scope of the Board of Vocational Nursing and Psychiatric Technicians of the State of California. The Prior Authorization LVN will promote the quality and cost effectiveness of medical care provided to patients by applying clinical acumen and using appropriate nationally recognized guidelines, criteria, and evidence-based standards. Also assists UM management and Compliance team in preparation for audits and other regulatory Activities as needed.

Primary Responsibilities:

• Acting within the scope of the Board of Vocational Nursing and Psychiatric Technicians of the State of California, ensures that prior authorization requests are appropriately reviewed and completed in a timely manner to meet contractual and regulatory requirements
• Coordinate and follow established prior authorization review process for outpatient and inpatient service requests
• Collaborates as directed with the Ambulatory Care Management Department or other departments as needed
• Accurate, thorough, and efficient review of prior authorization requests
• Timely review of prior authorization requests to include acute hospital pre-admission, surgical and diagnostic procedures, therapies, durable medical equipment, and home health care
• Conducts medical determinations based on nationally recognized and evidence-based guidelines, and in accordance with the policies and procedures approved by the physician group Medical Directors and UM Committees
• Audits and evaluates patient medical records when determining benefit coverage and medical necessity, including appropriateness and level of care
• Reviews prior authorization requests in coordination with group Medical Directors as required
• Other duties as assigned

 You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School or equivalent
• Graduation from an accredited LVN school of nursing or have completed coursework allowing candidate to challenge the VN Board of Nursing and attain LVN designation
• Current State of California LVN licensure, active and in good standing
• 2+ years of clinical experience in an acute or ambulatory patient care setting
• 1+ years of experience in a managed care environment such as a medical group, independent physician association, or health plan 
• Proficient in the application of Microsoft Word, Excel, Outlook, and the Internet
• Knowledge of Medicare, DMHC, NCQA, and MCG Guidelines

Preferred Qualifications:

•  3+ years of UM experience

Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California/Colorado/Connecticut/Nevada/New York City/Washington residents is $18.80 to $36.78. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, 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. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. 

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.