2 days old

Clinical Claims Review RN, Lead - LHI - Telecommute - 912104

Milwaukee, WI 53202 Work Remotely
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  • Job Code
    912104

AtOptum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone.

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LHIis one of 4 businesses underOptumServe.OptumServeprovides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans.By joiningOptumServeyou are part of the family of companies that makeUnitedHealth Groupa leader across most major segments in the U.S. health care system.

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LHIwas founded in 1999 and acquired byOptumin 2011,LHIspecializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, telehealth assessments, or any combination based on customer need.LHI'scustomizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

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There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doingyour life's best work. (sm)

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Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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The hours for this position are Monday through Friday, 10am - 7pm CST and/or 12pm - 9pmCST, including a weekend rotation.

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***Weekend Rotation -every 8-12 weeks and is a full-weekend rotation. You will be able to flex days during the week to account for those weekend days as well. ***

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Primary Responsibilities:

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  • Assist Clinical Operations Leadership Team in monitoring of all daily tasks completed within the Clinical Operations Department
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  • Provide guidance to staff in electronic processing of medical information in an internal database
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  • Perform QA of various medical services
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  • Assist front line staff with bringing ideas for process improvements to leadership
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  • Cultivate a positive environment while supporting team member growth
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  • Evaluate and process medical information for various service types
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  • Ongoing communication within Clinical Operations Department and other LHI departments to ensure exams are received from practitioners and processed in a timely manner
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  • Communicate with a diverse group of people/disciplines while serving as a point of contact (POC) for internal and external entities
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  • Monitor, manage and prioritize all Clinical Operations order related tasks for this role to facilitate controlled workflow to meet or exceed contractual requirements
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Youll 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.

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Required Qualifications:

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  • Associates degree in Nursing program with an RN licensure in your state of residence, OR Foreign Medical Graduate, OR MSW or LPC from an accredited university
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  • Understanding of regulatory standards and their application to various medical examinations and documents
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  • Equivalent combination of education, experience and/or applicable military experience will be considered
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  • Proficient use of computers
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  • Database experience
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  • Must possess excellent verbal and written communication skills
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  • Analytical thinking and teamwork skills
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  • Must be able to problem solve in a fast paced environment, multitask and meet tight deadlines
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  • Ability to perform detailed work with a high degree of accuracy
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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  • Minimum of 4 years of experience in a medical/surgical environment
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  • Occupational health and behavioral health experience
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  • Previous leadership experience
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  • Military background
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  • Knowledge of CPT and ICD10 coding
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  • Experience reporting statistical data
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  • National Career Readiness Certificate
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Be part of a health care team where technology, people and action combine to make great things happen every day. Join us and start doingyour life's best work.(sm)

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"Careers with LHI.Our focus is simple. We're innovators in cost-effective health care management. And when you join our team, you'll be a partner in impacting the lives of our customers, and employees. We've joined OptumHealth, part of the UnitedHealth Group family of companies, and our mission is to help the health system work better for everyone. We're located on the banks of the beautiful Mississippi River in La Crosse, Wis., with a satellite office in Chicago and remote employees throughout the United States. We're supported by a national network of more than 25,000 medical and dental providers. Simply put, together we work toward a healthier tomorrow for everyone. Our team members are selected for their dedication and mission-driven focus. For you, that means one incredible team and a singular opportunity to doyour life's best work.(sm)

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2018 OptumCare. All Rights Reserved.
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OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCares support services do not interfere with or control the practice of medicine by the medicalpractices or any of their physicians.

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Colorado Residents Only: The salary/hourly range for Colorado residents is $53,300to $95,100(add additional reference for sales and physicians). Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords:Supervisor, Lead, Team Lead, Leadership, Clinical Operations, Quality Assurance, QA, Clinical Review, Electronic Medical Records, Medical, Surgical, Med/Surg, Occupational Health, OT, Behavioral Health, Military, CPT, ICD10. ICD-10, Telecommute, Work from Home

Posted: 2021-06-11 Expires: 2021-07-11

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Clinical Claims Review RN, Lead - LHI - Telecommute - 912104

UnitedHealth Group
Milwaukee, WI 53202

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