Clinical Grievances Nurse - Work from home in TN - Full-time / Part-time

• Researching and investigating requests for information and complaints received from various sources related to member, provider, broker and employer grievances. Prepare summaries of findings


• Perform secondary research, including Internet searches, literature reviews, and other sources of secondary research. Prepare summaries of secondary research


• Responsible for handling High Risk Cases


• Responding within mandated timeframes to complaints received from the DOI's and other regulatory agencies


• Collaborating with the Appeals & Grievance Department to resolve complex issues received from the regulatory agencies, and coordinating responses to our members/providers


• Utilize negotiating skills in resolving issues and/or obtaining agreement with various internal departments that impact the customer experience


• Communicating both verbally and in writing to regulatory agencies as well as other internal departments


• Participate in meetings involving policy decisions as well as process improvement projects


• Write triages and clinical documentation


• Act as a resource for the triage analysts

Requirements:

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  Active and unrestricted RN license in the state of TN


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  3+ years' experience in medical/surgical unit, or other clinical experience in an inpatient/acute setting


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  Strong clinical writing skills


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  Investigative skills


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   Proficient level of experience with Microsoft Word, Excel, Outlook and Internet Explorer, with the ability to navigate a Windows environment

Additional Assets:

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  Experience with TN State requirements or regulations


• Experience in QA (quality assurance)


• Experience in clinical appeals and/or grievances HIGHLY preferred


• Knowledge of Care One or Facets

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 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: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.




UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.