Senior Clinical Administrative Nurse - Telecommute - Cotton, Arizona - Full-time / Part-time

Senior Clinical Administrative Nurse  - Telecommuter Cotton, Arizona

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work. (sm)

Primary Responsibilities:

·    Coordinates internal reviews on denial letters to determine compliance with contractual and regulatory requirements of the State Medicaid programs, while reviewing for efficiencies and effectiveness of procedures

·    Performs internal Quality Control reviews on processes and activities while developing recommendations for improvement

·     Serves as a catalyst for implementing an appropriate risk assessment process designed to identify and correct deficiencies

·    Assists with the coordination of external audits and reviews conducted by our clients or contracting organizations

·    Maintain extensive knowledge of regulatory and applicable accrediting body requirements becoming a Compliance resource for the team

·    Proficient in interpreting benefits, contracts, and medical policy

·    Review denial notice issued by the National Letter team to ensure accuracy and compliance, as well as providing recommendations for improvement, as needed

·    Interact effectively with other departments

·    Maintain knowledge of State rules, contracts, and Federal legislation/regulations as well as UnitedHealth Group guidelines

·    Establish and maintain good working relationships throughout the company to support goals and objectives

·    Demonstrate flexibility, availability, and dependability to conform to position responsibilities

Required

·         RN required

·         Three years of clinical experience

·         Proven analytical and problem solving skills while managing multiple tasks simultaneously

·         Ability to work independently or in a team environment

·         Demonstrated excellent written and verbal communication skills required

·         The applicant should possess a high attention to detail, exceptional documentation abilities, and organizational skills

·         Proven ability to meet critical deadlines consistently, while completing tasks accurately

·         Proven ability to handle multiple tasks simultaneously by working independently, as well as part of a team, in a fast paced environment

·         Flexibility needed for schedule, there may be Saturday required on a scheduled basis.

·         Excellent computer skills with direct experience in Microsoft Office, Word, and Excel required

·         Must be able to work in UnitedHealthcare's Cotton's office for training for external candidates.

Preferred Qualifications:

·         Knowledge of State Medicaid Rules and Long Term Care strongly preferred

·         Managed care experience or experience with a regulatory or accredited body strongly preferred

·         Bi-lingual Spanish

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.

Job Keywords: RN, Registered Nurse, Medicaid, Long Term Care, managed care, regulatory, accredited body, work at home, WAH, Telecommuter, Case Manager,  Bilingual