Clinical Consultant RN, Medical Policy Writer

UnitedHealth Group • Minnetonka, MN

256d • $89,800 - $176,700 • Remote

About The Position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

• Bachelor's degree in nursing or related field and medical-surgical clinical experience.
• Active, unrestricted Registered Nurse (RN) license.
• 3+ years of experience with scientific/medical literature search/retrieval/analysis.
• 3+ years of experience with clinical writing such as medical policies, utilization management guidelines, or patient education materials.
• Experience with public speaking including delivering presentations to professional and executive-level audiences.
• Familiarity with or experience in applying the principles of healthcare quality review.
• Proficient in use of Microsoft Word, PowerPoint, and Excel.
• Proven ability to build collaborative relationships with internal and external colleagues.

Nice To Haves

• Certification as a medical coder through American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or willingness to obtain within first year.

Responsibilities

• Clinical leadership of assigned Optum products.
• Research and development of product-specific clinical utilization management guidelines including annual literature/evidence reviews and shepherding the guidelines through the marketing and publication processes.
• Research and development of selection criteria for products with a centers of excellence (COE) network including annual literature/evidence reviews.
• Planning and execution of annual expert panel for assigned Optum products.
• Contribute to decision-making during annual network qualification for assigned Optum products including clinical evaluation of COE network status appeals and quality outcome reviews.
• Conduct quality of care investigations of adverse outcomes/events impacting members receiving services through an Optum product.
• Develop medical billing code sets for claims-based product analyses.
• Provide clinical support to product and network colleagues in claims analyses.
• Clinical support in development and market launch of new Optum products.
• Clinical support of CSI survey coordinators during product-specific network status qualification processes.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree