RN Full-time
UnitedHealthcare

Senior Clinical Quality RN - E&I LOB- Remote - EST or CST preferred

UnitedHealthcare Eden Prairie, MN, US
$72,800 - $130,000 / year
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

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

Primary Responsibilities
  • Representation of the Care Coordination of Utilization Review (UR) and Case Management (CM) services for E & I Clinical during external facing Commercial client audits
  • Analysis and demonstration of process and documentation of UR functions that integrate with CM business partners to reduce risk of readmission
  • Serves as a subject matter expert (SME) for Utilization Review standard process, specific to the client and commercial line of business, while participating in audit activities
  • Collaboration with internal business partners and leadership; providing clinical knowledge, critical thinking, and UR summaries for audit presentation
  • Post audit collaboration with business leaders to communicate findings and develop action plans to drive quality improvement
  • Performance Guarantee (PG) moniitoring to ensure compliance to the contractual agreement

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
  • Current, unrestricted Registered Nursing (RN) license
  • 1+ years of ICUE/OCM experience
  • Clinical expertise in utilization management processes, evidence-based guidelines, and the clinical operating system
  • Proven technical skills using Microsoft applications including Excel, PowerPoint, Word, and Adobe PDF
  • Proven flexible and self-directed with ability to manage priorities effectively
  • Demonstrated effective communication skills with an ability to present information to an audience
  • Proven detail-oriented with sound judgment and decision-making
  • Must have a designated workspace and access to install secure high-speed Internet via cable/DSL in home
  • Willing or ability to travel up to 25% and abide by all UHC travel requirements
  • 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 $72,800 to $130,000 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.

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