SSBV Clinical Claim Review RN

University of Minnesota School of Nursing; Plymouth (MN); On-site; USD 60,000 - 108,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

Dental, Vision, Life & AD&D Insurance

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Voluntary Benefits

Job summary

UnitedHealth Group is seeking a SSBV Clinical Claims Review RN for a remote role nationwide. You will perform administrative reviews of inpatient hospital claims, document determinations, and ensure accurate use of screening criteria to support member care and cost management.

The role offers autonomy with accountability in a fast-paced production environment, requiring office setup at home and strong MS Office and writing skills. Telecommuting from anywhere in the U.S. is supported.

Qualifications

• Associate's degree required.
• Current and unrestricted RN license in the state of residency.
• 5+ years of clinical documentation experience.
• 3+ years of RN experience in inpatient/acute settings.
• Intermediate proficiency in Microsoft Office (Excel and OneNote).
• Strong writing skills and ability to work from a home office with reliable high-speed internet.

Responsibilities

• Perform administrative reviews of short stay inpatient hospital claims in accordance with Federal, State and client specific requirements.
• Responsible for documentation of all determinations.
• Maintain accurate use of screening criteria.

Skills

RN license

Clinical documentation

MS Office

Writing

Home office setup

Education

Associate's degree

Undergraduate degree preferred

Tools

Microsoft Excel

OneNote

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together.

Let's face it, no industry is moving faster than health care. And no organization is better positioned to lead health care forward than UnitedHealthcare, part of the UnitedHealth Group family of businesses. As a SSBV Clinical Claims Review RN, you can put your skills and talents to work. This is a multifaceted role that is highly rewarding.

It feels great to have autonomy, though there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact on our members. And at the same time, you'll be challenged by a demanding case load in a rapidly changing, production-driven environment.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Perform administrative reviews of short stay inpatient hospital claims in accordance with Federal, State and client specific requirements
• Responsible for documentation of all determinations
• Maintain accurate use of screening criteria

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

Required Qualifications:

• Associate's degree
• Current and unrestricted RN license in the state of residency
• 5+ years of clinical documentation experience
• 3+ years of experience as an RN, including inpatient/acute setting
• Intermediate level of proficiency in Microsoft Office (to include Microsoft Excel and One Note)
• Intermediate level of proficiency in writing
• Designated home office workspace with access to install secure high-speed internet via cable/DSL

Preferred Qualifications:

• Undergraduate or higher degree
• A background in utilization review for an insurance company or experience in case management
• Familiarity with InterQual and/or MCG Care Guidelines
• Critical thinking skills

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN