Clinical Claim Review RN - Medical Disability - Remote

About the position

The Clinical Claim Review RN position at UnitedHealth Group involves evaluating and processing patient health information to determine outcomes for various medical and specialty exams. The role requires conducting clinical reviews of examination documentation, test results, and assessments, while collaborating with providers to ensure compliance with regulatory and contractual requirements. The position is remote, allowing flexibility to work from anywhere in the U.S., and includes responsibilities such as identifying behavioral health issues and providing exemplary service to providers.

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

Requirements

• 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 rotating weekends (approximately every 8 weeks)
• Distraction-free, dedicated space in home for home office
• Access to high-speed internet (cable, fiber optic)

Nice-to-haves

• 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 in 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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution