You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
- Function as a member of a self-directed team to meet specific individual and team performance metrics
- Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines
- Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
- Acts as a resource for others with less experience
- Work independently and collaborating with Medical Directors and non-clinical partners
- Adapt to a highly changing environment and a heavy case load
Required Qualifications
- Current unrestricted RN license in Oklahoma
- Professional experience in direct patient care
- Demonstrated proficiency in computer skills - Excel, Microsoft platforms, Outlook, clinical platforms
- Proven exemplary clinical documentation skills and critical thinking skills
- Designated secure workspace and access to install secure high speed internet via cable/DSL in home
- Flexible with work hours - hours/days can change as needed for the business
- Open to required weekend rotation schedule
- Reside in Oklahoma
Preferred Qualifications
- Bachelor's degree
- Compact RN license
- 2+ years of RN experience including experience in an inpatient/acute setting
- Background involving utilization review for an insurance company or experience in case management
- Proven excellent communication skills both verbal and written
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
The hourly pay for this role will range from $29 - $52 per hour based on full-time employment.