Sr Clinical Administration Nurse (Work from Home!) Job in San Antonio 78201, Texas US
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
We currently seek an experienced RN with strong interpersonal skills to join our team. The chosen Senior Clinical Administration Nurse would be responsible for reviewing incoming member cases to determine if the appropriate care was given. If you see yourself in home-based position that offers great potential for career advancement, we encourage you to apply today! In providing consumer-oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Work from home! Position can be based in any city! San Antonio, TX location preferred.
Primary Responsibilities:
- Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances)
- Clinical Interface/Liaison (clinical problem solver with facilities, providers, resolution of issues concerning members, program definition and clarification)
- Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits)
- Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
- Generally work is self-directed and not prescribed
- Works with less structured, more complex issues
- Solves moderately complex problems and/or conducts moderately complex analyses
- Translates concepts into practice
- Assesses and interprets customer needs and requirements
- Identifies solutions to non-standard requests and problems
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Provides explanations and information to others on difficult issues
- Coaches, provides feedback, and guides others
- Acts as a resource for others with less experience
Qualifications:
- A current, valid and unrestricted RN licensure in your state of residence is required
- 5+ years clinical experience in an acute care or an outpatient setting is also required
- 1+ year Medical record review/ appeal review experience required
- Strong Microsoft Office (Word, Excel Outlook) is required
- 3+ years of Utilization review and case management experience is strongly desired
- Experience working in a Managed Care environment is highly preferred
- Undergraduate degree is preferred
- ICD9 and CPT coding is preferred
- Strong analytical and research skills are preferred
UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:
UnitedHealthcare Employer Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.
UnitedHealthcare Medicare Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.
UnitedHealthcare Community State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.
Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.
Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.