Clinical Grievances RN -M-F, 8-5 (CST, PST or MST)

UnitedHealth Group • Las Vegas, NV

221d • $59,500 - $116,600 • Onsite

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Location/Hours: Must reside in CST, MST, PST time zone and work Monday - Friday 8am-5pm within their time zone.

Requirements

• Current, unrestricted RN license in the state of residence
• 3+ years of total RN experience including recent clinical experience in an inpatient / acute setting or similar setting
• 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 (minimum speed 1.5 download mps & 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement)
• Ability to work Monday - Friday 8am-5pm within their time zone (PST, MST or CST)

Nice To Haves

• Experience in medical necessity review, medical record review, medical record audits
• Experience in collaborating with physicians and other healthcare professionals
• Proven adaptable to change while providing exemplary clinical documentation skills and critical thinking skills
• Proven organizational, analytical, critical thinking and communication skills
• Proven sound clinical judgment while applying medical necessity to assess appropriateness of healthcare services provided
• Proven ability to identify opportunities for improved communication or processes
• Proven ability to work seamlessly and independently in multiple computer platforms

Responsibilities

• Performing clinical assessment of healthcare services provided to our members for appropriateness
• Understanding relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported
• Facilitating telephonic discussion with health care providers and/or members to obtain additional clinical information
• Providing timely, quality service to members and providers while upholding UnitedHealthcare culture values
• Acting as a resource for others with less experience
• Working independently and collaborating with Medical Directors and non-clinical partners
• Functioning as a member of a self-directed team to meet specific individual and team performance metrics
• Managing and maintaining quality and productivity metrics
• Document relevant chronology of case review and provide rationale for severity level, descriptor codes, and any applicable Improvement Action Plan (IAP) implemented

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: No Education Listed