5 days old

Clinical Claims Review RN - Telecommute

La Crosse, WI 54601 Work Remotely
  • Job Code

The UnitedHealth Group family of businesses. As a Clinical Claims Review Nurse, you can put your skills and talents to work, reviewing cases with treating physicians and other health care professionals to ensure our members receive the proper health services. This is a multifaceted role that is highly rewarding as your work is helping people live healthier lives.


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


***Required schedule is Monday-Friday, 10:00am-7:00pm CENTRAL TIME.  Weekend responsibilities also required on a rotating basis.***


Primary Responsibilities:

  • Navigate and work within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams
  • Conduct a clinical review of a variety of examination documentation, test results, assessments and information to provide a clear, comprehensive and concise final product
  • Utilize clinical judgement to identify quality assurance issues and make recommendations to reconcile documentation
  • Collaborate with providers via the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposes
  • Possess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needs
  • Identify emergent behavioral health issues and initiate intervention when necessary
  • 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 in regards to 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 
  • Answer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams, and lab results and provide exemplary service to providers and patients with appointment questions
  • May flex into other assignments within Clinical Operations department utilizing nursing skills, as needed

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. 



Posted: 2020-06-29 Expires: 2020-07-29

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Clinical Claims Review RN - Telecommute

UnitedHealth Group
La Crosse, WI 54601

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