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Clinical Reviewer, RN / LCSW - Work-at-h
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Clinical Reviewer, RN / LCSW - Work-at-home program!
Company: UnitedHealth Group
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UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards.
If you're a talented clinician who's ready to harness your expertise in a new way, consider this unique role in our Cypress location. The Sr. Clinical Review Nurse is a telephonic position that would tap your communication skills and provide you with tremendous flexibility and advancement potential in a supportive team environment. We offer great perks, advancement opportunities and an ideal work-at-home program.
Primary responsibilities include:
Addressing urgent and emergent cases
Ensuring our department is compliant with HIPAA and Department of Managed Health Care regulations
Working to mitigate risk by researching issues, resolving complaints and following up with members
Collaborating with Utilization Review staff and other internal departments
Conducting concurrent reviews of member treatment
Handling and documenting escalated issues from callers
The chosen candidate must be an RN or LCSW with a current and unrestricted license in the state of California. A varied clinical background (e.g. home health, ICU, concurrent review and/or case management) is needed. Professional telephonic experience is key. Problem-solving skills are essential. Computer proficiency is a must. Bilingual (Spanish/English) skills are ideal. A Bachelor's degree is highly preferred, and a CPHQ designation is a plus.
UnitedHealth Group offers a full range of comprehensive benefits, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.
Keywords: registered nurse, licensed clinical social worker, healthcare, insurance, inpatient, outpatient, work from home, customer service, nursing, triage, underutilization, disease management, HMO, managed care