Clinical Grievances RN - Telecommute in Missouri
Company: UnitedHealth Group
Location: Saint Louis
Posted on: August 7, 2022
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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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