Remote Clinical Grievances RN – Phoenix, AZ

Requisition Number: 2185987
Job Category: Nursing
Primary Location: Phoenix, AZ
(Remote considered)

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

As the new Clinical Grievances Nurse, you will be responsible for reviewing incoming member cases to determine if the appropriate care was given.

In providing consumer – oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary 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
• 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

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:

• Current, unrestricted RN license in the state of residency
• 3+ years of total RN experience including clinical experience in an inpatient / acute setting
• Demonstrated clinical documentation skills and critical thinking skills
• Demonstrated proficiency in computer skills – Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel, and Outlook
• Designated workspace and access to install secure high speed internet via cable / DSL in home
• Must live in CST or PST and work 8-5 in their time zone

Preferred Qualifications: 

• Bachelor’s in Nursing or higher
• Experience with Managed Care Clinical Quality Programs
• Case management experience
• Clinical appeals and grievances experience
• Audit / chart review experience
• Experience in a telecommuting role
• Demonstrated ability to effectively utilize UHG applications, including but not limited to authorization applications, auto correspondence, and member & provider demographic systems

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $56,300 to $110,400. 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 Policy