Radiation Oncology Preservice Review Nurse RN - Remote

OverviewRequisition number: 2353367 "” Nursing role with Optum. Telephonic Oncology Preservice Review Nurse performing pre-service clinical coverage reviews of services requiring notification, using benefit plan documents, evidence-based medical policy and clinical guidelines to determine medical appropriateness of outpatient services.This is a work-from-home position with a full-time schedule and some flexibility, including a combination of day and consumer hours; evenings, holidays and weekend hours may be required. Core schedule is daytime hours with occasional evenings and weekends based on business needs.Primary ResponsibilitiesDetermine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial)Validate that cases/requests for services require additional research; identify and utilize appropriate resources to conduct non-clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources)Prioritize cases based on appropriate criteria (e.g., date of service, urgency, expedited)Ensure compliance with applicable federal/state requirements and mandates (e.g., turnaround times, medical necessity)Review/interpret clinical/medical records submitted from provider (e.g., office records, test results, prior operative reports)Identify missing information from clinical/medical documentation and request additional medical or clinical documentation as needed (e.g., LOI process, phone/fax)Review and validate diagnostic/procedure/service codes to ensure relevance and accuracy, as applicable (e.g., PNL list, EPAL list, state grid, LCDs, NCDs)Identify and validate usage of non-standard codes, as necessary (e.g., generic codes)Apply understanding of medical terminology and disease processes to interpret medical/clinical recordsMake determinations per relevant protocols (e.g., approval, denial, further clinical or non-clinical research)Review care coordinator assessments and clinical notes, as appropriateIdentify relevant information needed to make medical or clinical determinationsIdentify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG, medical references)This position requires active and unrestricted nursing licensure in multiple US states; selected candidate must be willing and able to obtain and maintain multiple state licensure (application fees and filing costs paid by UnitedHealth Group)Required QualificationsCurrent, unrestricted RN license in your state of residenceAbility to obtain licensure in other states as needed2+ years of Radiation Oncology experience as a nurseComputer proficiency, including solid data entry skills and the ability to navigate a Windows environmentAccess to high-speed internet from home (Broadband, Fiber or DSL)Dedicated workspace for home office setupAbility to work the schedule listedPreferred QualificationsOCN CertificationChemo/Bio CertificationCertified Case Manager (CCM)7+ years of Radiation Oncology experienceICD coding experience or solid knowledge of codesNCCN experienceBackground in preservice review/utilization review/utilization managementAll employees working remotely will be required to adhere to UnitedHealth Group's telecommuter policy. UnitedHealth Group is an Equal Employment Opportunity employer and maintains a drug-free workplace. #J-18808-Ljbffr

Created: 2026-04-20