Clinical Claim Review RN – Medical Disability – Remote

Job title: Clinical Claim Review RN – Medical Disability – Remote

Company: UnitedHealth Group


Job description: For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.Position in this function navigates and works within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams. Conduct a clinical review of a variety of examination documentation, test results, assessments and information to provide a clear, comprehensive and concise final product. Utilize clinical judgement to identify quality assurance issues and make recommendations to reconcile documentation. Collaborate with providers via the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposes. Possess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needs. Identify emergent behavioral health issues and initiate intervention when necessary.The Required Schedule For This Position IsMonday through Friday: 1:00pm to 10:00pm EST | 12:00pm to 9:00pm CST | 11:00am-8:00pm MST | 10:00AM-7:00PM PSTRotating Weekends (approximately Every 8 Weeks) Are RequiredYou’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities

• Remain up to date with the contract requirements
• Use clinical judgement to ensure a clear, comprehensive, and concise exam documentation that is reflective of the patient’s service level conditions and in compliance to contract requirements
• Interpret and document diagnostic test results
• Educate and support provider with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork
• Answer calls that come into the Clinical Operations Review queue regarding medical or specialty exams and provide exemplary service to providers with appointment questions
• Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high-risk intervention process
• Complete system generated tasks to process exam documentation
• Interface via telephone and e-mail with contracted providers in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol

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

• Accredited Associate’s Degree in Nursing (ADN) OR Bachelor’s Degree in Nursing (BSN)
• Current RN license in your state of residency
• 2+ years of experience in a clinical environment as a Registered Nurse
• Experience working in an Electronic Medical Record system
• Understanding/knowledge of regulatory standards and their application to various examinations and documents
• Proficient computer skills including Microsoft Office programs and database experience
• Ability to work rotating weekends (approximately every 8 weeks)
• Distraction-free, dedicated space in home for home office
• Access to high-speed internet (cable, fiber optic)

Preferred Qualifications

• Experience in an Intensive Care Unit or Emergency Room
• Prior authorization, utilization management/review experience
• Experience reviewing medical disability claims
• Knowledge or experience in:

• Clinical quality assurance
• Auditing and compliance
• Education of clinical staff
• Clinical documentation improvement
• Clinical experience:

• Neurological
• Cardiovascular or Respiratory units
• ISO 9001 standards
• Healthcare regulatory and accreditation standards
• Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
• Military experience
• Proven ability to collaborate with providers to ensure quality patient outcomes
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $28.61 to $56.06 per hour 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.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.

Expected salary:

Location: La Crosse, WI

Job date: Sun, 02 Mar 2025 08:51:06 GMT

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