Remote RN: Clinical Grievances Reviewer (CA)

UnitedHealth Group; Arizona; Remote; USD 82,656,000 - 148,781,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Job summary

UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases for appropriate care and address members’ immediate needs. The role embraces remote PST hours with an on-site base in Mesa, AZ, requiring CA residency and an active CA RN license.

You will assess care against standards, collaborate with clinicians, and document case chronology and severity rationale while supporting providers and members via telecommunication.

Qualifications

• RN license in the state of residency required
• 3+ years of total RN experience including recent clinical experience in an inpatient/acute setting
• Current, unrestricted RN license in the state of CA

Responsibilities

• Perform clinical assessment of healthcare services provided to members for appropriateness
• Understand relevant state and federal grievance and peer review requirements
• Receive cases from the QIS non-clinical team and review against required clinical information
• Document relevant chronology of case review and provide rationale for severity level
• Facilitate telephonic discussions with healthcare providers and/or members
• Provide timely, quality service to members and providers
• Act as a resource for others with less experience
• Work independently and collaborate with Medical Directors and non-clinical partners
• Function as a member of a self-directed team to meet performance metrics
• Manage and maintain quality and productivity metrics

Education

RN license (CA residency)

Job description

UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases for appropriate care and address members’ immediate needs. The role embraces remote PST hours with an on-site base in Mesa, AZ, requiring CA residency and an active CA RN license.

You will assess care against standards, collaborate with clinicians, and document case chronology and severity rationale while supporting providers and members via telecommunication.