Remote Clinical Grievances RN – CA | PST Hours

UnitedHealthcare

Mesa (AZ)

Remoto

USD 40.000 - 72.000

Tempo pieno

27 ore fa

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Descrizione del lavoro

UnitedHealthcare is seeking a Clinical Grievances RN to work remotely in California. The role involves reviewing retrospective cases for appropriateness and ensuring member needs are addressed, with collaboration from Medical Directors and non-clinical partners.

Remote PST hours are provided, Monday–Friday, 8 am–5 pm PST, to support patient-centered care. Required are an active RN license in the state of residence and 3+ years of RN experience, plus strong computer skills and documented clinical

Competenze

Current, unrestricted RN license in the state of residency.
3+ years of total RN experience including inpatient/acute setting.
Proficiency with Windows, MS Office, and clinical platforms.
Demonstrated clinical documentation and critical thinking skills.
Designated home workspace with secure high-speed internet

Mansioni

Perform clinical assessment of healthcare services for appropriateness.
Review applicable grievance and peer review requirements and standards.
Evaluate cases from non-clinical team against required clinical info with Medical Director input.
Document chronology and provide rationale for severity level and IAP where applicable.
Telephonically discuss cases with providers and members to obtain more information.
Provide timely, quality service while upholding company values and collaborating with team