Supervisor Clinical Review RN - National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Supervisor will demonstrate a comprehensive and impactful role in setting and overseeing the direction of the clinical review team, addressing departmental needs, and ensuring operational priorities and deadlines are met. This position will provide guidance to team members and with decision-making processes along with assisting with the implementation of improved process and procedures. The Supervisor must demonstrate a thorough understanding of the clinical IBR review process and will play a pivotal role in ensuring the accuracy and consistency of claims reviews, while fostering team and stakeholder relationships, and driving continuous improvement within the department.

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

Primary Responsibilities:

• Oversees and prioritizes production goals and quality targets for individuals and department
• Sets team direction, delegates assignments, assists with issue resolution and provides guidance to team members
• Assists with departmental needs and priorities to address business and operational challenges
• Creates and contributes to the development of team processes, improvement and planning for enhancement of policies and procedures
• Assists with ensuring accuracy and consistency performed with policies and procedures
• Develops, communicates and maintain relationships with applicable internal business partners for outcomes on reviews or concerns/inquiries
• Conducts/utilizes investigations to determine accuracy of claims adjustments (prospectively and retrospectively)
• Investigates and creates client requirements requested for clarity, accuracy and application of adjustments
• Performs research to support audit adjustments and resolve issues
• Research reference materials for clinical standards as appropriate
• Performs and provides oversight of special project assignments
• Research, reviews and documents outcomes of special project requests
• Understands and maintains HIPAA confidentiality and privacy standards when completing assigned work
• Participates in department and company meetings as requested

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:

• Associate's Degree (or higher)
• Active and unrestricted Nursing license in the state of residence, BSN preferred
• 5+ years of experience working in a clinical role
• 2+ years of experience with billing, charge master and compliance
• 2+ years of experience working with plan benefit language, CMS (Medicaid and Medicare) and UB 04 billing guidelines
• 2+ years of clinical experience in an acute care setting practice

Preferred Qualifications:

• Auditing and coding certifications
• Strong written and verbal communication skills
• Proficient with medical record review and analytical research
• Advanced Microsoft Office computer skills
• Ability to multi-task and work with little direction
• Excellent organizational abilities, critical thinking skills, and attention to detail
• Proficiency with medical terminology and coding

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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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