Medical Claims Review RN

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

 

This is a non-exempt (hourly) position that is overtime eligible with a Monday – Friday schedule. Due to business needs, residency in the Eastern or Central time zone is preferred.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

• Perform clinical coverage review services which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
• Function as a member of a self-directed team to meet specific individual and team performance metrics
• Communicate in writing and verbally all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations, and reimbursement determinations
• Act as a resource for others with less experience
• Work independently and collaborate with Medical Directors and non-clinical partners
• Adapt to a highly changing environment and a heavy case load

 

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 residency
• 3+ years of direct patient acute care experience, preferably in a hospital setting
• Proficient computer skills including Microsoft Windows, Word, Excel, Teams, and Outlook
• Solid clinical background including exemplary proven clinical documentation and critical thinking skills
• Access to secure high-speed internet at home via cable broadband, DSL, or fiber
• Dedicated, distraction-free workspace at home 

Preferred Qualifications:

• Bachelor’s Degree
• Compact RN license OR the ability to obtain one
• Experience reviewing a wide variety of outpatient medical claims including initial reviews and reconsiderations
• Experience working with the Medicare population
• Experience performing utilization review at an insurance company
• Experience providing case management
• Experience or familiarity with Interqual
• Proven excellent verbal and written communication skills
• Proven ability to work seamlessly and independently in multiple computer platforms
• Proven self-starter with the ability to handle a fast-paced production environment and multiple review types
• Proven ability to be flexible and willing to adapt to an ever-changing environment
• Reside in the Eastern or Central time zone

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

 

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