SSBV Clinical Claim Review Nurse Manager - Remote

SSBV Clinical Claim Review Nurse Manager - Remote

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

Let's face it, no industry is moving faster than health care. And no organization is better positioned to lead health care forward than UnitedHealthcare, part of the UnitedHealth Group family of businesses. As a SSBV Clinical Claim Review Nurse Manager - Remote, you can put your skills and talents to work. This is a multifaceted role that is highly rewarding.

In this role, you will lead a team responsible for clinical reviews using established guidelines, clinical criteria, and applicable state and federal requirements. Your work will support accurate, well-documented determinations. The SSBV Clinical Claim Review Nurse Manager - Remote must be flexible and adaptable in a fast-paced, production-driven environment.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Manage a team responsible for completing administrative short-stay inpatient hospital reviews in accordance with federal, state, and client-specific requirements
• Support the Assistant Director with Post Pay SSBV claim assignments, including offshore staff assignments, workflow coordination, and inventory management
• Participate in client implementations
• Troubleshoot client-specific computer platforms
• Provide education and training for new SSBV Nurse Auditors and maintain current training materials
• Maintain and compile individual client statistics and reporting in collaboration with the business analyst
• Provide ongoing coaching, mentoring, and support to Nurse Auditors and Medical Directors who need guidance with questions, issues, or complex reviews
• Oversee quality assurance for onshore and offshore RN teams
• Complete administrative responsibilities, including timesheets, performance reviews and goals, and monthly coaching
• Collect and monitor staff performance metrics
• Ensure adherence to company policies, including attendance, telecommuting, and other applicable requirements
• Communicate process and policy updates to staff in a timely, clear manner
• Address escalated manager-level issues
• Communicate effectively, both verbally and in writing
• Work independently and collaboratively with clinical teams, Medical Directors, and non-clinical partners
• Adapt effectively to a rapidly changing 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 may be interested in.

Required Qualifications:

• Active, unrestricted RN license
• 5+ years of RN experience, including experience in an inpatient or acute care setting
• 5+ years of clinical documentation experience
• Leadership or supervisory experience
• Solid experience reviewing medical records
• Solid computer skills, including Microsoft Excel, OneNote, multiple systems, keyboarding, and basic IT troubleshooting
• Highly organized with solid, persuasive communication skills
• Demonstrated solid analytical, problem-solving, and decision-making skills, with sound judgment
• Demonstrated ability to adapt to changing environments, incorporate new information, and apply best practices
• Designated home office workspace with secure high-speed internet access via cable or DSL

Preferred Qualifications:

• Bachelor's degree
• Utilization review experience with an insurance company or case management experience
• Knowledge of health insurance operations, industry terminology, and regulatory guidelines
• Solid knowledge of InterQual and/or MCG Care Guidelines
• Solid critical thinking skills and sound clinical judgment
• Proven excellent verbal and written communication skills
• Proven ability to remain flexible and adapt to a changing environment

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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