UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Sr Clinical Admin Nurse - RN Required - Wausau, WI-316346
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards.
This function includes RN (with current licensure) roles responsible for providing clinical expertise in any of the following areas:
- Clinical Appeals: analyzing, reviewing and evaluating appeals, adverse determination;
- Clinical Interface/Liaison: clinical problem solver with facilities, providers, employer groups/plan holder; resolution of issues concerning members, benefit interpretation, program definition and clarification , work with external independent reviewers;
- Clinical Operations Analysis: clinical audits within clinical appeal review, clinical review of medical necessity, options network review for clinically eligible for coverage, clinical guidelines for medical appropriateness;
- Clinical Training: planning, coordinating, delivering and evaluating clinical training within appeal unit;
- Clinical Writing: writing rationale regarding adverse determination (overturning or upholding the denial)
Job Environment:
o Generally work is self-directed and not prescribed.
o Works with less structured, more complex issues.
o Serves as a resource to others.
o Assesses and interprets customer needs and requirements.
o Identifies solutions to non-standard requests and problems.
o Solves moderately complex problems and/or conducts moderately complex analyses.
o Works with minimal guidance; seeks guidance on only the most complex tasks.
o Translates concepts into practice.
o Provides explanations and information to others on difficult issues.
o Coaches, provides feedback, and guides others.
o Acts as a resource for others with less experience. Qualifications Job Requirements
- Valid RN, unrestricted in the state of WI.
- Minimum 5 years clinical experience
- Undergraduate degree or equivalent experience.
- Understand and interpret specific customer plan language
- Solid Computer skills
Additional assets include:
- Ability to look at records, information and all facts
- Problem solving
- Ability to look at the big picture
- Team player
- Diplomatic
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.
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. |
