[Hiring] Clinical Grievances RN - Behavioral Health @UnitedHealth Group

Role Description

As the new Clinical Grievances Nurse, you will be responsible for reviewing incoming member cases to determine if the appropriate care was given.

This role is a fully remote position but must be located in PST, MST, CST or AZ and able to work Monday-Friday 8A-5P within their time zone.

Primary Responsibilities:

• Perform clinical assessment of healthcare services provided to our members for appropriateness.
• Understand relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported.
• Facilitate telephonic discussion with health care providers and/or members to obtain additional clinical information.
• Provide timely, quality service to members and providers while upholding UnitedHealthcare culture values.
• Act as a resource for others with less experience.
• Work independently and collaborating with Medical Directors and non-clinical partners.
• Function as a member of a self-directed team to meet specific individual and team performance metrics.
• Manage and maintain quality and productivity metrics.

Qualifications

• Current, unrestricted RN license in the state of residency.
• Experience working in the Behavioral Health field as an RN.
• 3+ years of total RN experience including clinical experience in an inpatient / acute setting.
• Demonstrated clinical documentation skills and critical thinking skills.
• Demonstrated proficiency in computer skills - Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel, and Outlook.
• Designated workspace and access to install secure high speed internet via cable / DSL in home.
• Live in CST, PST, MST or AZ and work 8-5 in their time zone.

Requirements

• Bachelor’s in Nursing or higher (Preferred).
• Experience with Managed Care Clinical Quality Programs (Preferred).
• Case management experience (Preferred).
• Clinical appeals and grievances experience (Preferred).
• Audit / chart review experience (Preferred).
• Experience in a telecommuting role (Preferred).
• Demonstrated ability to effectively utilize UHG applications, including but not limited to authorization applications, auto correspondence, and member & provider demographic systems (Preferred).

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

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.