Supervisor Clinical Claim Review – Telecommute

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.(sm)

The Optum Care Clinical Claim Review team conducts retrospective, post-service clinical reviews to determine medical appropriateness of inpatient level of care retro, first and second level reconsideration; and outpatient professional services. This role is responsible for coordination, supervision and is accountable for the daily activities related to the retrospective review of medical claims and application of medical and reimbursement policies. A solid knowledge of claims processing, medical claim review and utilization management to lead a team of nurses in outpatient professional and inpatient level of care reviews, and effectively move between review types as needed to support the team.

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

Primary Responsibilities:

• Supervise and coordinate daily work activities of the CCR team
• Monitor, create reports, and set priorities for the team productivity, metrics, and quality audits to ensure established standards are met
• Monitor individual performance of direct reports, provide monthly and annual metrics on scorecards with actionable feedback
• Collaborate with physicians, claims operations, prior authorization, utilization management, local market teams and support staff as needed
• Develop plans to meet short-term objectives
• Identify and resolve operational problems using defined processes, expertise and clinical judgment
• Decisions are guided by policies, procedures and business plan
• Reviews and updates job aids to maximize quality and productivity
• Fields questions and serves as a resource for clinical and non-clinical staff
• Actively participate in projects and leadership meetings
• Solid communication, presentation and writing skills
• Ability to work independently and make sound decisions in a fast-paced environment

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 be interested in.

Required Qualifications:

• Current unrestricted RN licensure in applicable state
• 2+ years of experience with data analysis
• Working knowledge of claims processing and medical necessity review
• Advanced experience using Microsoft Office applications (Word, Excel, PowerPoint)

Preferred Qualifications:

• BSN degree or related field
• Medicare experience, especially Medicare Advantage
• Leadership experience
• Solid attention to detail and accuracy, excellent evaluative and analytical skills

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement result in rescission of an employment offer or termination of employment

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut / Nevada residents is $72,800 to $129,900. 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 Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.