Clinical Claims Review RN - Remote

UnitedHealth Group • Full-time • Eden Prairie, MN, US • $28 - $54 / hour • 2d ago

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.

The schedule is Monday - Friday during standard business hours in the local time zone. Flexibility within those hours may be offered after training.

This is a non-exempt (hourly) position that is overtime eligible based on business needs.

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
Participate in telephonic discussions with health care providers and/or members to explain benefit coverage determinations and obtain additional clinical information
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 RN experience including in an inpatient / acute setting
Proven solid clinical background including exemplary proven clinical documentation and critical thinking skills
Proficient computer skills including Microsoft Windows, Word, Excel, Teams, and Outlook
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 performing utilization review at an insurance company
Experience providing case management
Proven 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
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Maryland, Rhode Island, Washington, 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 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: 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.

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