Remote Preservice Review RN – Full‑Cycle Prior Authorization, Inpatient Care Management & Discharge Coordination Specialist (Work‑From‑Home)

Why Join Optum? A Visionary Leader Shaping the Future of Health Care

At Optum, a division of UnitedHealth Group, we harness cutting‑edge technology, data analytics, and compassionate clinical expertise to transform the way millions of people access and experience health care. Our mission—“help people live healthier lives and make the health system work better for everyone”—is not just a statement; it is a daily commitment that guides every decision we make.

As a Preservice Review Nurse (RN) working remotely, you will be part of an integrated, cross‑functional team that blends clinical acumen with innovative digital tools to streamline prior authorization, inpatient care management, discharge planning, and post‑acute coordination. You’ll be instrumental in reducing unnecessary barriers, accelerating treatment pathways, and ultimately improving outcomes for members across the United States.

Optum’s culture is built on diversity, inclusion, and relentless curiosity. We celebrate the unique perspectives each teammate brings, and we invest heavily in professional development, mentorship, and well‑being. When you partner with us, you become part of a global community that values your growth as much as the health of the patients you serve.

Position Overview: Remote Preservice Review RN – Clinical Excellence Meets Flexibility

Working from the comfort of your home—or any U.S. location that meets our telecommuter policy—you will serve as a critical gatekeeper in the health‑care continuum. Your role will span four core domains:

• Prior Authorization (PA): Evaluate clinical requests against evidence‑based criteria (InterQual, coverage determinations, and internal policies) to approve, deny, or request additional information.
• Inpatient Care Management (ICM): Oversee concurrent reviews of inpatient admissions, ensuring appropriate utilization and coordinating with medical directors for complex cases.
• Discharge Care Management (DCM): Guide patients through safe, timely discharge plans, linking them with post‑acute services and follow‑up care.
• Post‑Acute Care Management (PACM): Provide oversight of rehabilitation, skilled nursing, and long‑term care transitions, safeguarding continuity of care.

This multifaceted position demands clinical judgment, strong communication, and the agility to switch between roles as workload fluctuates. You will collaborate closely with physicians, case managers, health‑plan partners, and medical directors, delivering decisions that are both clinically sound and aligned with regulatory standards.

Key Responsibilities – What Your Day Looks Like

Clinical Review & Decision Making

• Conduct comprehensive initial and ongoing reviews for PA, ICM, DCM, and PACM cases, applying InterQual and other evidence‑based criteria.
• Document clinical rationales, approve or deny requests, and forward adverse determinations to medical directors for peer review.
• Maintain meticulous records in compliance with federal, state, and accreditation standards (e.g., CMS, NCQA).

Collaboration & Communication

• Partner with medical directors, internal case managers, and external physicians to clarify clinical information and facilitate appropriate care pathways.
• Lead virtual case discussions, providing education on policy updates, documentation best practices, and emerging clinical guidelines.
• Serve as a resource for peers, answering complex clinical questions and mentoring newer team members.

Process Improvement & Education

• Participate in regular team meetings, quality improvement initiatives, and continuing education sessions.
• Identify trends in utilization, propose data‑driven solutions, and contribute to the evolution of the integrated care model.
• Stay current on changes to National and Local Coverage Determinations, payer policies, and clinical best practices.

Compliance & Documentation

• Follow all Standard Operating Procedures (SOPs) for case intake, documentation, and escalation.
• Ensure accurate, timely entry of all case details into Optum’s proprietary platforms and electronic health record (EHR) systems.
• Adhere to UnitedHealth Group’s Telecommuter Policy, maintaining a secure, HIPAA‑compliant workspace.

Essential Qualifications – The Foundations You Bring

• Active, unrestricted RN license in the state of residence (or compact license where applicable).
• Minimum of three (3) years of registered nursing experience in a clinical setting.
• Proficiency with Microsoft Office Suite (Teams, Word, Excel, Outlook) and comfort navigating web‑based clinical platforms.
• Demonstrated ability to work independently, manage time effectively, and meet productivity targets.
• Excellent verbal and written communication skills, with a talent for translating complex clinical information into clear recommendations.
• Flexibility to work weekends as needed to support 24/7 service coverage.

Preferred Qualifications – What Sets You Apart

• Bachelor of Science in Nursing (BSN) or Master of Science in Nursing (MSN) – although not mandatory, it is highly valued.
• Compact RN license enabling multi‑state practice.
• Two (2) or more years of case management experience, preferably within a payer or health‑plan environment.
• Clinical experience in inpatient/acute care, long‑term care, acute rehabilitation, or skilled nursing facilities.
• Hands‑on experience with discharge planning, utilization review, or case coordination.
• Familiarity with InterQual criteria, utilization management software, and electronic health records.
• Commitment to ongoing professional development and pursuit of certifications such as CNU (Certified Nurse Utilization) or CCM (Certified Case Manager).

Core Skills & Competencies – The Attributes That Drive Success

• Clinical Judgment: Ability to synthesize patient data, apply evidence‑based guidelines, and make decisive, patient‑centred recommendations.
• Analytical Thinking: Comfortable working with large data sets, identifying utilization trends, and recommending system‑wide improvements.
• Effective Communication: Clear, concise, and empathetic interaction with providers, patients, and internal stakeholders.
• Time Management: Prioritization of high‑volume case loads while maintaining accuracy and compliance.
• Adaptability: Seamlessly transition between PA, ICM, DCM, and PACM responsibilities as team needs evolve.
• Technology Savvy: Navigating multiple digital platforms, including EHRs, case‑management tools, and collaborative software.
• Ethical Integrity: Upholding the highest standards of patient privacy, regulatory compliance, and professional conduct.

Career Growth & Learning Opportunities – Your Path Forward

Optum believes that a thriving employee is a continuously learning employee. As a Remote Preservice Review RN, you will have access to:

• Comprehensive onboarding and mentorship programs that pair you with seasoned clinical leaders.
• Tuition assistance and reimbursement for advanced nursing degrees, certifications, and continuing education.
• Internal mobility pathways to roles such as Clinical Informatics Specialist, Utilization Management Lead, or Health‑Plan Operations Manager.
• Regular webinars, workshops, and conferences focused on emerging trends in health‑technology, value‑based care, and population health.
• Performance‑based recognition programs, including bonuses, awards, and opportunities to present innovative projects to senior leadership.

Work Environment & Culture – A Remote Experience That Feels Connected

While your physical office may be your home office, your professional community is anything but isolated. Optum cultivates a virtual environment that promotes collaboration, inclusion, and well‑being:

• Flexibility: Choose a work schedule that respects your personal life while meeting service coverage requirements.
• Diversity & Inclusion: Join a workforce that reflects the communities we serve, and participate in employee resource groups (ERGs) that celebrate various identities and perspectives.
• Well‑Being Resources: Access to mental‑health counseling, ergonomic guidance, and virtual fitness programs.
• Technology Support: Company‑provided hardware, secure VPN access, and a dedicated IT helpdesk to ensure seamless remote operations.
• Team Bonding: Regular virtual town halls, coffee chats, and celebratory events to foster camaraderie across geographic borders.

Compensation, Perks & Benefits – A Holistic Rewards Package

Optum offers a competitive hourly wage ranging from $28.03 to $54.95, based on factors such as location, experience, education, and certifications. In addition to salary, you will receive a robust benefits suite that includes:

• Medical, dental, and vision coverage with multiple plan options.
• Prescription drug benefits and a Health Savings Account (HSA) option.
• Retirement savings plans with company matching contributions (401(k) or 403(b)).
• Equity stock purchase plans, allowing you to invest in the company’s future.
• Paid time off (PTO), holidays, and flexible leave policies.
• Employee assistance programs (EAP) for personal and professional challenges.
• Recognition programs that reward outstanding performance with bonuses, gift cards, and public acknowledgment.
• Opportunities to participate in community outreach and volunteer initiatives, reinforcing our commitment to health equity.

All benefits are subject to eligibility criteria and may vary by state.

How to Apply – Take the Next Step Toward Impactful Nursing Leadership

If you are a motivated RN who thrives in a dynamic, remote environment and is eager to make a tangible difference in health‑care delivery, we want to hear from you. Follow these steps to submit your application:

1. Click the “Apply To This Job” button below.
2. Complete the online application, attaching an up‑to‑date resume and a concise cover letter outlining your relevant experience and why you’re excited about this role.
3. Pass a pre‑employment drug screening and the UnitedHealth Group Telecommuter Policy compliance review.
4. Participate in a virtual interview process that may include a case‑study exercise to showcase your clinical decision‑making skills.

Our recruitment team reviews applications on a rolling basis. Early applicants are encouraged to apply promptly, as the posting may close sooner than the listed deadline due to high interest.

Closing Statement – Join Us in Redefining Health Care

At Optum, you will not just fill a position—you will become a catalyst for change, helping millions navigate the complex health‑care system with clarity, compassion, and confidence. Your expertise in preservice review, care management, and discharge planning will directly influence patient outcomes and cost‑effective care delivery.

Ready to bring your nursing expertise to a forward‑thinking, remote‑first organization that values your growth as much as the health of its members? Apply today and embark on a career where innovation meets impact.

Apply To This Job