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Clinical Grievances RN - Telecommute in Missouri

Company: UnitedHealth Group
Location: Saint Louis
Posted on: August 7, 2022

Job Description:

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)If you are located in Missouri, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:Performing clinical assessment of healthcare services provided to our members for appropriatenessUnderstanding relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supportedFacilitating telephonic discussion with health care providers and/or members to obtain additional clinical informationProviding timely, quality service to members and providers while upholding UnitedHealthcare culture valuesActing as a resource for others with less experienceWorking independently and collaborating with Medical Directors and non-clinical partnersFunctioning as a member of a self-directed team to meet specific individual and team performance metricsManaging and maintaining quality and productivity metricsDocument relevant chronology of case review and provide rationale for severity level, descriptor codes, and any applicable Improvement Action Plan (IAP) implementedYou'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 Missouri3+ 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 OutlookDesignated 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)Reside in Missouri and work Monday - Friday 8am-5pm within their time zonePreferred Qualifications:Experience in medical necessity review, medical record review, medical record auditsExperience in collaborating with physicians and other healthcare professionalsAbility to work seamlessly and independently in multiple computer platformsAdaptable to change while providing exemplary clinical documentation skills and critical thinking skillsOrganizational, analytical, critical thinking and communication skillsSound clinical judgment while applying medical necessity to assess appropriateness of healthcare services provided Identify opportunities for improved communication or processesFull COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodationTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employmentCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.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.

Keywords: UnitedHealth Group, St. Louis , Clinical Grievances RN - Telecommute in Missouri, Healthcare , Saint Louis, Missouri

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