5 days old

RN Quality Letter Reviewer Bilingual Spanish PreferredTelecommute in US

Phoenix, AZ 85003
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  • Job Code
    885783
  • Jobs Rated
    118th

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) 

 

The successful candidate will be ensuring that the Adverse Letters comply with all applicable State and Federal laws and consent decrees, as well as the applicable accrediting regulatory review agencies, including but not limited to CMS, NCQA, HIPAA, and all UHC policies and procedures as applicable.

 

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

 

Work schedule requirement is Monday through Friday   

9am to 6pm Pacific Time

10am - 7pm Mountain Time

 


 

  Primary Responsibilities:

  • Coordinates internal reviews on denial letters to determine compliance with contractual and regulatory requirements of the State and Federal 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 UHG 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
  • Ability to work independently or in a team environment  
  • The applicant should possess a high attention to detail, exceptional documentation abilities, and organizational skills

You'll 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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Jobs Rated Reports for Registered Nurse

Posted: 2020-09-16 Expires: 2020-10-16

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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RN Quality Letter Reviewer Bilingual Spanish PreferredTelecommute in US

UnitedHealth Group
Phoenix, AZ 85003

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Registered Nurse
118th2018 - Registered Nurse
Overall Rating: 118/220
Median Salary: $70,000

Work Environment
Poor
166/220
Stress
High
173/220
Growth
Good
53/220
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