Clinical Grievances RN -M-F, 8-5 (CST, PST or MST)

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 

Location/Hours: Must reside in CST, MST, PST  time zone and work Monday – Friday 8am-5pm within their time zone

Primary Responsibilities:

• Performing clinical assessment of healthcare services provided to our members for appropriateness
• Understanding relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported
• Facilitating telephonic discussion with health care providers and/or members to obtain additional clinical information
• Providing timely, quality service to members and providers while upholding UnitedHealthcare culture values
• Acting as a resource for others with less experience
• Working independently and collaborating with Medical Directors and non-clinical partners
• Functioning as a member of a self-directed team to meet specific individual and team performance metrics
• Managing and maintaining quality and productivity metrics
• Document relevant chronology of case review and provide rationale for severity level, descriptor codes, and any applicable Improvement Action Plan (IAP) implemented

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.

Required Qualifications:

• Current, unrestricted RN license in the state of residence 
• 3+ years of total RN experience including recent clinical experience in an inpatient / acute setting or similar setting 
• 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 (minimum speed 1.5 download mps & 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement)
• Ability to work Monday – Friday 8am-5pm within their time zone  (PST, MST or CST)

Preferred Qualifications:

• Experience in medical necessity review, medical record review, medical record audits
• Experience in collaborating with physicians and other healthcare professionals
• Proven adaptable to change while providing exemplary clinical documentation skills and critical thinking skills
• Proven organizational, analytical, critical thinking and communication skills
• Proven sound clinical judgment while applying medical necessity to assess appropriateness of healthcare services provided 
• Proven ability to identify opportunities for improved communication or processes
• Proven ability to work seamlessly and independently in multiple computer platforms 

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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