886974 Lead Clinical Review LHI LaCrosse WI andor Telecommute

Improve the lives of others while doing your life's best work.SM

Lead Clinical Review - LHI - LaCrosse, WI and/or Telecommute (886974)

Position Description

At Optum, the mission is clear:  Help people live heathier lives and help make the health system work better for everyone


LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well-being of Americans.


By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.


LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on-location services, patient-specific in-clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.


There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work.(sm) 


We are currently seeking a Lead, Clinical Review.  If located in the LaCrosse, WI area may be required to come into the office.  If outside of the area this is a telecommute position.


In this Lead Clinical Review role, you will assist the Clinical Operations Leadership Team in monitoring of all daily tasks completed within the Clinical Operations Department.


Primary Responsibilities:

  • Provide guidance to staff in electronic processing of medical information in an internal database
  • Perform QA of various medical services
  • Assist front line staff with bringing ideas for process improvements to leadership
  • Cultivate a positive environment while supporting team member growth
  • Evaluate and process medical information for various service types
  • Ongoing communication within Clinical Operations Department and other LHI departments to ensure exams are received from practitioners and processed in a timely manner
  • Communicate with a diverse group of people/disciplines while serving as a point of contact (POC) for internal and external entities
  • Monitor, manage and prioritize all Clinical Operations order related tasks for this role to facilitate controlled workflow to meet or exceed contractual requirements
  • Additional responsibilities as assigned, including working in production

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in



Please Note: In order to be considered for this position, you must be able to obtain an SF86 Position of Trust which is only available to U.S. Citizens. Our Facilities Security Officer will initiate this process post-offer acceptance. Failure to obtain this will result in termination from this role.

Required Qualifications:

  • Current, unrestricted RN, LPC or LSW licensure in your state of residency OR a Foreign Medical Graduate
  • Minimum of 4 years of experience post licensure or if FMG 4 years’ experience in clinical review
  • Understanding of regulatory standards and their application to various medical examinations and documents
  • Equivalent combination of education, experience and/or applicable military experience will be considered
  • Proficient use of computers
  • Database experience
  • Must possess excellent verbal and written communication skills
  • Analytical thinking and teamwork skills
  • Must be able to problem solve in a fast-paced environment, multitask and meet tight deadlines
  • Ability to perform detailed work with a high degree of accuracy


Preferred Qualifications:

  • Occupational health and behavioral health experience 
  • Previous leadership experience
  • Military background
  • Knowledge of CPT and ICD10 coding
  • Experience reporting statistical data
  • National Career Readiness Certificate


Careers with LHI. Our focus is simple. We're innovators in cost-effective health care management. And when you join our team, you'll be a partner in impacting the lives of our customers, and employees. We've joined OptumHealth, part of the UnitedHealth Group family of companies, and our mission is to help the health system work better for everyone. We're located on the banks of the beautiful Mississippi River in La Crosse, Wis., with a satellite office in Chicago and remote employees throughout the United States. We're supported by a national network of more than 25,000 medical and dental providers. Simply put, together we work toward a healthier tomorrow for everyone. Our team members are selected for their dedication and mission-driven focus. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)


OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 


Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.



Job Keywords: nursing, RN, FMG, medical/surgical, occupational health, behavioral health, military, CPT, ICD10, clinical review, Telecommute

  • Requisition Number886974
  • Job TitleLead Clinical Review - LHI - LaCrosse, WI and/or Telecommute
  • Job FamilyNursing
  • Business SegmentOptumCare

Job Location Information

  • La Crosse, WI
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusNon-exempt