Remote Sr. Clinical Grievances RN – MST, PST or AZ

UnitedHealthcare

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Requisition Number: 2222430
Job Category: Nursing
Primary Location: Denver, CO
(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.

 

If you are located within MST, PST, or AZ, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges.

 

Primary Responsibilities:

  • Proficient in review of medical records and the ability to identify pertinent information on which to base appropriate clinical decisions.
  • Document relevant chronology of case review and provide rational for determination
  • Plan, prioritizes, organizes and completes work to meet established objectives.
  • Excellent verbal and written communication skills with internal and external customers
  • Understanding relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported
  • Facilitating telephonic discussion with health care providers and/or members to obtain additional clinical information
  • Providing timely, quality service to members and providers while upholding UnitedHealthcare culture values
  • Acting as a resource for others with less experience
  • Working independently and collaborating with Medical Directors and non-clinical partners
  • Functioning as a member of a self-directed team to meet specific individual and team performance metrics
  • Managing and maintaining quality and productivity metrics
  • Investigates concurrent and retrospective quality of care concerns

 

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:

  • Registered Nurse with active unrestricted license in the state of residence
  • Ability to obtain Colorado state nursing license upon 6 months of hire if currently don’t hold a CO license
  • 3+ years of clinical experience in an inpatient / acute setting
  • Proficient in Microsoft Word, Excel and Outlook
  • Adhere to a work schedule of M-F 8-5P MST,PST or AZ

 

Preferred Qualifications:

  • 3+ years of behavioral health clinical experience in an inpatient / acute setting
  • Proven adaptable to change while providing exemplary clinical documentation skills and critical thinking skills
  • Proven sound clinical judgment while applying medical necessity to assess appropriateness of healthcare services provided
  • Proven ability to identify opportunities for improved communication or processes
  • Proven ability to work in ever changing, fast-paced environment while maintaining a flexible approach to change
  • Proven ability to manage conflict effectively

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

California, Colorado, Nevada, or Washington Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable. 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.

 

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.