Job Description
PHRNs who are planning to take the NCLEX soon are also welcome to apply.
Join Optum and help make the health system work better for everyone. The US Registered Nurse reviews medical requests to make sure services are medically necessary and aligned with clinical guidelines. This role works closely with doctors, care teams, and insurance partners to support safe, appropriate, and cost‑effective patient care.
Role Overview:
You will conduct clinical coverage reviews for services requiring prior authorization. Using evidence‑based guidelines, medical policies, and benefit documentation, you will assess the medical necessity and appropriateness of both inpatient and outpatient services.
Your work helps members, providers, and care teams feel confident in the quality and integrity of our clinical decisions—giving you the opportunity every day to do your life’s best work.