Preservice Review Nurse

About the role

Optum is seeking a Preservice Review Nurse to join its utilization management team. In this role you will support prior‑authorization and clinical review processes, helping to ensure appropriate care delivery for members across the United States.

Key responsibilities

• Perform preservice review and prior‑authorization assessments for inpatient and outpatient services.
• Conduct utilization review and management activities, including telephonic and remote evaluations.
• Apply ICD‑10 and CPT coding standards to support clinical decisions.
• Utilize InterQual or Milliman criteria to determine medical necessity.
• Maintain compliance with company policies, contractual obligations, and regulatory requirements.

Required profile

• Bachelor’s degree in Nursing.
• Active USRN license (mainland United States) and PHRN certification.
• Minimum 1 year of hospital nursing experience or 2 years of utilization management nursing experience.

Required skills

• Prior Authorization experience.
• Telephonic and/or telecommute experience.
• Utilization Review/Management expertise.
• Knowledge of ICD‑10 and CPT coding.
• Familiarity with InterQual or Milliman criteria.

What we offer

• Inclusive culture focused on diversity and equity.
• Comprehensive benefits and career development opportunities.
• Drug‑free workplace environment.