Clinical Grievances - Remote in PST, MST and CST
About The Position
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together As the new Clinical Grievances Nurse, you will be responsible for reviewing incoming member cases to determine if the appropriate care was given. In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. If you are located within PST, CST, MST time zones, you will have the flexibility to work remotely as you take on some tough challenges. Please note this team is not planning on hiring for 6-8 weeks so the hiring process will be slower than usual.
Requirements
- Current, unrestricted RN license in the state of residency
- 3+ years of total RN experience including clinical experience in an inpatient / acute setting
- Demonstrated clinical documentation skills and critical thinking skills
- Demonstrated proficiency in computer skills - Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel, and Outlook
- Designated workspace and access to install secure high speed internet via cable / DSL in home
- Live in PST, CST, or MST and work 8-5 in their time zone
Nice To Haves
- Bachelor’s in Nursing or higher
- Experience with Managed Care Clinical Quality Programs
- Case management experience
- Clinical appeals and grievances experience
- Audit / chart review experience
- Experience in a telecommuting role
- Demonstrated ability to effectively utilize UHG applications, including but not limited to authorization applications, auto correspondence, and member & provider demographic systems
Responsibilities
- Perform clinical assessment of healthcare services provided to our members for appropriateness
- Understand relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported
- Facilitate telephonic discussion with health care providers and/or members to obtain additional clinical information
- Provide timely, quality service to members and providers while upholding UnitedHealthcare culture values
- Act as a resource for others with less experience
- Work independently and collaborating with Medical Directors and non-clinical partners
- Function as a member of a self-directed team to meet specific individual and team performance metrics
- Manage and maintain quality and productivity metrics
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
