UnitedHealth Group

UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of

Clinical Claims Review RN

Location

United States

Posted

23 days ago

Salary

$29 - $52 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Clinical Claims Review RN

UnitedHealth Group

Role Description As a SSBV Clinical Claims Review RN, you can put your skills and talents to work in a multifaceted role that is highly rewarding. You will be accountable for making decisions that directly impact our members while managing a demanding case load in a rapidly changing, production-driven environment. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Perform administrative reviews of short stay inpatient hospital claims in accordance with Federal, State and client specific requirements - Responsible for documentation of all determinations - Maintain accurate use of screening criteria Qualifications - Associate's degree - Current and unrestricted RN license in the state of residency - 5+ years of clinical documentation experience - 3+ years of experience as an RN, including inpatient/acute setting - Intermediate level of proficiency in Microsoft Office (to include Microsoft Excel and One Note) - Intermediate level of proficiency in writing - Designated home office workspace with access to install secure high-speed internet via cable/DSL Requirements - Undergraduate or higher degree (preferred) - A background in utilization review for an insurance company or experience in case management (preferred) - Familiarity with InterQual and/or MCG Care Guidelines (preferred) - Critical thinking skills (preferred) Benefits - Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays - Medical Plan options along with participation in a Health Spending Account or a Health Saving account - Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage - 401(k) Savings Plan, Employee Stock Purchase Plan - Education Reimbursement - Employee Discounts - Employee Assistance Program - Employee Referral Bonus Program - Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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