Remote Clinical Manager - Prepay Claims Validation

UnitedHealth Group; Plymouth (MN); Hybrid; USD 92,000 - 164,000; Full time

Job summary

UnitedHealth Group is seeking a Prepay Claim Validation Clinical Manager to lead a staff of clinical investigators auditing medical records and making pay/deny decisions on claims, while overseeing inventory for 5+ clients.

The role emphasizes leadership, process improvement, and collaboration across matrix partners, with remote work flexibility within the U.S. and in-office days in the Minneapolis area.

Qualifications

• Active nursing credential or certified coder.
• 3+ years of management experience
• 3+ years Payment Integrity FWAE Clinical Team and Process experience
• 2+ years of human resource policies and procedures experience
• 2+ years managing in a production-based environment
• 2+ years working in a matrix-driven organization
• 2+ years of experience in supporting clients with varying requirements
• 2+ years of experience in interpretation of data trends and driving solutions
• Preferred: ICD 10/ICD 9 coder, RN/LPN, CMS experience
• Proficient in MS Office with multiple systems experience
• Ability to adapt in changing environments and strong communication skills
• Strong analytical, problem-solving and decision-making skills

Responsibilities

• Provide collaborative leadership to matrix partners to meet client-savings targets and internal revenue goals
• Provide client-facing support to clients and ongoing operations
• Anticipate Client needs and proactively develop solutions
• Lead client implementation readiness and inventory management controls
• Perform data analysis of staff performance to identify gaps
• Consult with partners on operational impacts and analytics discussions
• Develop staffing models by client and ensure timely, high-quality reviews
• Coordinate with Procurement and partners for vendor resources
• Drive process improvements and training with leads
• Co-lead with offshore partners to achieve high client NPS
• Understand cross-client impacts of changes and balance competing client interests

Skills

Nurse/Coder credentials

Management experience

Data interpretation

Policy/Procedures knowledge

Matrix organization experience

Client-facing support

Leadership and development

Job description

UnitedHealth Group is seeking a Prepay Claim Validation Clinical Manager to lead a staff of clinical investigators auditing medical records and making pay/deny decisions on claims, while overseeing inventory for 5+ clients.

The role emphasizes leadership, process improvement, and collaboration across matrix partners, with remote work flexibility within the U.S. and in-office days in the Minneapolis area.