Claim Review RN - Telecommute in Oklahoma - Oklahoma City, OK - Telemetry

Company: UnitedHealth Group
Location: Oklahoma City
Posted on: September 24, 2022

Job Description:

Claim Review RN - Telecommute in Oklahoma - Oklahoma City, OKCombine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) The Clinical Claim Review Nurse is responsible for performing clinical reviews post service utilizing established guidelines and clinical criteria along with state and federal mandates and applicable benefit language to make determinations that drive better provider and member outcomes and lower the cost of care. --The Clinical Claim Review Nurse works in a fast paced, ever changing environment with a vigilant focus on improving the member and provider experience. If you are located in the state of Oklahoma, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:

• Perform clinical reviews, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
• Function as a member of a self-directed team to meet specific individual and team performance metrics
• Communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations
• Work independently and collaboratively with Medical Directors and non-clinical partners
• Adapt to a highly changing environment and a heavy case load You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:
  • A current unrestricted RN license in Oklahoma
  • Must reside in State of Oklahoma
  • 3+ years total RN experience including clinical experience in an inpatient / acute setting
  • Exemplary clinical documentation skills
  • Demonstrated proficiency in computer skills - Windows, Instant Messaging, Microsoft Suite including Word, Excel and Outlook
  • Must have a quiet secure designated work space and access to install secure high speed internet (minimum speed 1.5 download mps & 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc does not meet this requirement) Preferred Qualifications:
    • Bachelor's Degree
    • RN License in an NLC (Nurse License Compact) state or the ability to apply and meet requirements for one
    • Professional coding certification and/or core understanding of ICD-10 and CPT/HCPCS codes
    • Medicaid or Government Program experience for certain government positions
    • Familiarity with Milliman Care Guidelines or InterQual
    • Solid clinical judgement while applying medical necessity based on approved clinical resources--
    • Background involving utilization review for an insurance company, experience in case management, or experience with clinical claim review --
    • The ability to be flexible and willing to adapt to an ever-changing environment
    • Excellent time management, organizational and prioritization skills to balance multiple priorities
    • Self-starter with the ability to handle a fast-paced production environment and multiple review types--
    • Solid written, verbal, analytic, organizational, time management and problem-solving skills
    • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, Oklahoma City , Claim Review RN - Telecommute in Oklahoma - Oklahoma City, OK - Telemetry, Healthcare , Oklahoma City, Oklahoma