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 - Behavioral Health

Location

United States

Posted

3 days ago

Salary

$60.2K - $107.4K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Clinical Grievances RN - Behavioral Health

UnitedHealth Group

Role Description As the new Clinical Grievances Nurse, you will be responsible for reviewing incoming member cases to determine if the appropriate care was given. This role is a fully remote position but must be located in PST, MST, CST or AZ and able to work Monday-Friday 8A-5P within their time zone. 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. - 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. Qualifications - Current, unrestricted RN license in the state of residency. - Experience working in the Behavioral Health field as an RN. - 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 CST, PST, MST or AZ and work 8-5 in their 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). - Demonstrated 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). 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.

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