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Clinical Grievance Nurse -Telecommute in Louisiana
| Hours | Full-time, Part-time |
|---|---|
| Location | Baton Rouge, LA Baton Rouge, Louisiana |
About this job
There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work. (sm)
Nurse! Clinical Grievances! Work from home! Monday - Friday!
As the NEW Clinical Grievances Nurse, you will be responsible for reviewing incoming member cases to determine if the appropriate care was given. In this exciting and challenging role you will also work closely with our risk management department to prevent future hospitalizations. If you see yourself in this home - based (telecommuting) position that offers a Monday - Friday schedule, with great potential for career advancement, APPLY TODAY!
In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Primary Responsibilities:
- Clinical Grievances (analyzing, reviewing and evaluating quality of care concerns and grievances)
- Clinical Interface/Liaison (clinical problem solver with facilities, providers, resolution of issues concerning members, 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 Writing (writing nursing tools and reference information to support the design of clinical products and services)
- Solves moderately complex problems and/or conducts moderately complex analyses
- Translates concepts into practice
- Assesses and interprets customer needs and requirements
- Identifies solutions to non-standard requests and problems
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Provides explanations and information to others on difficult issues
- Coaches, provides feedback, and guides others
Requirements
Required Qualifications:
- A current, valid and unrestricted RN licensure in the state of Louisiana
- MS Office proficiency with the ability to navigate through multiple systems
- 3 years of clinical experience in an acute care setting
- Access to high speed Internet
Preferred Qualifications:
- Experience with Managed Care Clinical Quality Programs is a plus!
- Case management experience
- Clinical appeals and grievances experience
- BSN
- Previous experience in a telecommuting role
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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, 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: Clinical Grievances Nurse, RN, Nurse, Clinical, Grievances, Quality, Quality Management, Risk Management, Review, Case Management, Case Manager, BSN, work from home, telecommuting, telecommute, UHG, UnitedHealth Group, UHC, Unitedhealthcare, Health Insurance, Managed Care, Louisiana, LA