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UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)If you are located in the EST Time Zone, you will have the flexibility to telecommute* as you take on some tough challenges.Primary Responsibilities:Log in to the computer system to check email and review daily calendar; launch and log in to any systems used during the day, such as QCare, RightFax, ICUE, and CommunityCareReceives prepped cases from the QIS non- clinical team and reviews them against required clinical information, assessing for appropriateness and consulting with a Medical Director as neededDocument relevant chronology of case review and provide rationale for severity level, descriptor codes, and any applicable Improvement Action Plan (IAP) implementedLog out of any systems used during the day and out of computerAssesses and interprets customer needs and requirementsIdentifies solutions to non-standard requests and problemsSolves moderately complex problems and / or conducts moderately complex analysesWorks with minimal guidance; seeks guidance on only the most complex tasksWorks concurrent and retrospective grievancesProvides explanations and information to others on difficult issueCoaches, provides feedback, and guides othersYou'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:Undergraduate degree and/or 2 equivalent years of related experienceActive, Unrestricted RN licenseDemonstrated proficiency in computer skills - Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel, and OutlookDemonstrated clinical documentation skills and critical thinking skillsDesignated work space and access to install secure high speed internet via cable / DSL in homePreferred Qualifications:Undergraduate degree2+ years of Appeals and Grievances experienceAble to effectively utilize UHG applications related to quality of care case research, including but not limited to authorization applications, auto correspondence, and member & provider demographic systemsExperience working on a virtual teamAbility to work in ever changing, fast-paced environment while maintaining a flexible approach to changeExcellent verbal & written communication skills with internal & external customersTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.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)*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut/Nevada residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.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.
Location/Region: Tampa, FL (33602)