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 Grievances RN

Location

United States

Posted

3 days ago

Salary

$29 - $52 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Clinical Grievances RN

UnitedHealth Group

Role Description As a Clinical Grievances Nurse, you will be responsible for reviewing incoming retrospective cases to determine if the appropriate care was given along with current cases to ensure the members' immediate needs are being addressed. 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 able to work PST hours, you’ll enjoy the flexibility to work remotely from anywhere in the U.S. as you take on some tough challenges. The working hours for this role are Monday – Friday, 8 am - 5 pm PST or CST (Whichever time zone you are within). Primary 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. - Receive cases from the QIS non-clinical team and review them against required clinical information, assessing for appropriateness and consulting with a Medical Director. - Document relevant chronology of case review and provide rationale for severity level, descriptor codes, and any applicable Improvement Action Plan (IAP) implemented. - 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 collaborate 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. Qualifications - Current, unrestricted RN license in the state of residency. - 3+ years of total RN experience including recent clinical experience in an inpatient/acute setting or similar 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. - Reside in and work 8 am-5 pm in Central or Pacific Standard time zone. Requirements - Bachelor’s in Nursing or higher (Preferred). - Experience with Managed Care Clinical Quality Programs (Preferred). - Case management experience (Preferred). - Clinical appeals and grievances experience (Preferred). - Audit/chart review experience (Preferred). - Experience in a telecommuting role (Preferred). - Ability to effectively utilize UHG applications, including but not limited to authorization applications, auto correspondence, and member & provider demographic systems (Preferred). Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). - Hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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