Remote Grievances RN - Clinical Appeals & Quality

UnitedHealth Group; Mesa (AZ); Remote; USD 40,000 - 72,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase program

401(k) contribution

Job summary

UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases and current cases ensuring appropriate care and addressing immediate member needs. This role offers PST hours with remote work options and a Monday–Friday schedule.

You will perform clinical assessments, consult Medical Directors, document case chronology, and communicate with providers to obtain needed information while upholding UHG values.

Qualifications

• 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.
• Designated workspace and secure home internet access.
• Reside in and work 8 am-5 pm Pacific Standard Time zone.

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.
• Receives cases from the QIS non-clinical team and reviews them against required clinical information, assessing for appropriateness and consulting with a Medical Director.
• Document relevant chronology of case review and provide rationale for severity level, descriptor codes, and any applicable Improvement Action Plan (IAP) implemented.
• 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.

Skills

RN license

Clinical assessment

Inpatient experience

Computer skills

Documentation skills

Telecommuting

PT hours

Education

Bachelor's in Nursing or higher

Tools

Windows

Microsoft Office

Clinical Platforms

Job description

UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases and current cases ensuring appropriate care and addressing immediate member needs. This role offers PST hours with remote work options and a Monday–Friday schedule.

You will perform clinical assessments, consult Medical Directors, document case chronology, and communicate with providers to obtain needed information while upholding UHG values.