SSBV Clinical Claim Review Nurse Manager - Remote

UnitedHealth Group•Plymouth, MN

4d•$91,700 - $163,700•Remote

About The Position

Optum Insight is seeking an SSBV Clinical Claim Review Nurse Manager to lead a team conducting administrative short-stay inpatient hospital reviews. The role ensures reviews follow established guidelines, clinical criteria, and applicable federal, state, and client-specific requirements, supporting accurate and well-documented determinations. The manager supports Post Pay SSBV claim assignments and workflow coordination, oversees quality assurance and staff performance, and provides training, coaching, and guidance to Nurse Auditors and Medical Directors. The position requires flexibility and adaptability in a fast-paced, production-driven environment. The role is remote within the United States. Employees hired in the Minneapolis or Washington, D.C. area must work in the office at least four days per week. Remote employees must comply with UnitedHealth Group’s Telecommuter Policy and have a designated home office workspace with secure high-speed internet access via cable or DSL.

Requirements

Active, unrestricted RN license.
At least 5 years of RN experience, including experience in an inpatient or acute care setting.
At least 5 years of clinical documentation experience.
Leadership or supervisory experience.
Solid experience reviewing medical records.
Solid computer skills, including Microsoft Excel, OneNote, multiple systems, keyboarding, and basic IT troubleshooting.
Highly organized with solid, persuasive communication skills.
Demonstrated analytical, problem-solving, and decision-making skills, with sound judgment.
Demonstrated ability to adapt to changing environments, incorporate new information, and apply best practices.
Designated home office workspace with secure high-speed internet access via cable or DSL.

Nice To Haves

Bachelor’s degree.
Utilization review experience with an insurance company or case management experience.
Knowledge of health insurance operations, industry terminology, and regulatory guidelines.
Solid knowledge of InterQual and/or MCG Care Guidelines.
Solid critical thinking skills and sound clinical judgment.
Excellent verbal and written communication skills.
Ability to remain flexible and adapt to a changing environment.

Responsibilities

Manage a team completing administrative short-stay inpatient hospital reviews in accordance with federal, state, and client-specific requirements.
Support the Assistant Director with Post Pay SSBV claim assignments, including offshore staff assignments, workflow coordination, and inventory management.
Participate in client implementations.
Troubleshoot client-specific computer platforms.
Provide education and training for new SSBV Nurse Auditors and maintain current training materials.
Maintain and compile individual client statistics and reporting in collaboration with the business analyst.
Provide ongoing coaching, mentoring, and support to Nurse Auditors and Medical Directors regarding questions, issues, or complex reviews.
Oversee quality assurance for onshore and offshore RN teams.
Complete administrative responsibilities, including timesheets, performance reviews and goals, and monthly coaching.
Collect and monitor staff performance metrics.
Ensure staff adherence to company policies, including attendance and telecommuting requirements.
Communicate process and policy updates to staff in a timely and clear manner.
Address escalated manager-level issues.
Communicate effectively, verbally and in writing.
Work independently and collaboratively with clinical teams, Medical Directors, and non-clinical partners.
Adapt effectively to a rapidly changing environment.