Job: Sr Clinical Admin Nurse, Member Appeals: Cypress, CA or Telecommuter Opportunity

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Jobing Description

If you're interested in bringing your nursing experience (as an RN, LPN or LVN) to a role that offers regular, Monday through Friday business hours and ample potential for advancement, apply to join us as one of our newest Senior Clinical Admin Nurses for our Member Appeals team! The chosen candidate will perform clinical reviews to ensure compliance with clinical standards, appeal/grievance procedures and coding practices, and to identify quality issues. In addition, you can earn an opportunity to work from home!

You will be responsible for providing clinical expertise in any of the following areas:

-Clinical Appeals (analyzing, reviewing and evaluating appeals, quality of care concerns/grievances);
-Clinical Interface/Liaison (clinical problem solver with facilities, providers, carriers; resolution of issues concerning members, benefit interpretation, program definition and clarification);
-Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits);
-Clinical Training (planning, coordinating, delivering and evaluating clinical training);
-Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services).

Skills / Requirements

The chosen candidate must possess:

Current, unrestricted RN, LPN or LVN license in your state of residence

Minimum 1 year of clinical experience gained in an acute care or outpatient setting

MS Office and Internet proficiency

Strong organizational skills

Strong communication skills, written and verbal

Candidates who also have one or more of the following will be preferred:

Appeals experience strongly preferred

CPT and/or ICD 9 experience is strongly preferred

Medicare policy knowledge is preferred

Managed care experience is strongly preferred

Utilization review and/or case management experience is preferred

BSN

CCM

Previous experience in a telephonic role'

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we are removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.