ROLE AND RESPONSIBILITIES

• The Clinical Appeals Nurse in Optum will ensure defensible and accurate case recommendations for concurrent admission, continued stay, and concurrent denial cases which are then reviewed by a Physician Advisor for completion of the concurrent and/or peer to peer review. They will be working directly with the Physician Advisors utilizing the guidance provided in order to make defensible and accurate case recommendations.

Your role is critical in allowing our members, families, facilities and health professionals to have greater confidence in the exceptional care we provide. And for you, an everyday opportunity to do your life’s best work.

JOB QUALIFICATIONS

Primary Profile

• PHRN with active license
• Strong Clinical Knowledge base with a minimum of 2 years of Critical Care bedside experience in a tertiary hospital (local/overseas)...