Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Join us. Take this opportunity to start doing your life's best work.(sm) Primary Responsibilities:Identifies the appropriate work processes to support continuous compliance Maintains Current operational knowledge of regulatory compliance Manages staff to consistently accomplish desired results Manages staff and operations; including recruitment/coaching/hiring/terminations Monitors compliance and quality work product Establish performance measures Conduct performance reviews Motivation and recognition of staff Maintain High level of morale and performance Clinical Appeals (analyzing, reviewing and evaluating appeals, quality of care concerns (grievances) Clinical Interface / Liaison (clinical problem solver with facilities, providers, carriers; resolution of issues concerning members, benefit interpretation, program definition and clarification) Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits) Clinical Training (planning, coordinating, delivering and evaluating clinical training) Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services) - Generally work is self - directed and not prescribed Works with minimal guidance; seeks guidance on only the most complex tasks Assesses and interprets customer needs and requirements
Required Qualifications:RN licensure in State of Residence 5 or more years of clinical experience as an RN 1 or more years of clinical appeals experience Proficient in MS Word and MS Excel Strong analytical skills Strong service orientation Ability to work independently Excellent oral, written and interpersonal communication skills Excellent organizational skills Ability to work 8 AM - 5 PM Central Time Preferred Qualifications: 1 or more years of management / supervisor experience Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) 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. Job Keywords: Manager, Supervisor, Clinical Appeals, Healthcare, Clinical Operations, Clinical Training
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.