For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.Position in this function navigates and works within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams. Conduct a clinical review of a variety of examination documentation, test results, assessments and information to provide a clear, comprehensive and concise final product. Utilize clinical judgement to identify quality assurance issues and make recommendations to reconcile documentation. Collaborate with providers via the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposes. Possess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needs. Identify emergent behavioral health issues and initiate intervention when necessary.The required schedule for this position is:Monday through Friday: 1:00pm to 10:00pm EST | 12:00pm to 9:00pm CSTRotating weekends (approximately every 8 weeks) are requiredYou’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
Remain up to date with the contract requirements
Use clinical judgement to ensure a clear, comprehensive, and concise exam documentation that is reflective of the patient’s service level conditions and in compliance to contract requirements
Interpret and document diagnostic test results
Educate and support provider with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork
Answer calls that come into the Clinical Operations Review queue regarding medical or specialty exams and provide exemplary service to providers with appointment questions
Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high-risk intervention process
Complete system generated tasks to process exam documentation
Interface via telephone and e-mail with contracted providers in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol
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:
Accredited Associate's Degree in Nursing (ADN) OR Bachelor’s Degree in Nursing (BSN)
Current RN license in your state of residency
2+ years of experience in a clinical environment as a Registered Nurse
Experience working in an Electronic Medical Record system
Understanding/knowledge of regulatory standards and their application to various examinations and documents
Proficient computer skills including Microsoft Office programs and database experience
Ability to work 1:00pm to 10:00pm ET/12:00pm to 9:00pm CT/11:00am to 8:00pm MT/10:00am to 7:00pm PT
Ability to work rotating weekends (approximately every 8 weeks)
Distraction-free, dedicated space in home for home office
Access to high-speed internet (cable, fiber optic)
Preferred Qualifications:
Experience in an Intensive Care Unit or Emergency Room
Prior authorization, utilization management/review experience
Experience reviewing medical disability claims
Knowledge or experience in:
Clinical quality assurance
Auditing and compliance
Education of clinical staff
Clinical documentation improvement
Clinical experience:
Neurological
Cardiovascular or Respiratory units
ISO 9001 standards
Healthcare regulatory and accreditation standards
Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
Military experience
Proven ability to collaborate with providers to ensure quality patient outcomes
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyAt 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.Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
