At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Clinical Quality LPN engages in a collaborative process with members of a multidisciplinary team which may include a Physician, Nurse Practitioner, RN Care Manager, Social Worker, Pharmacist, Clinical Quality Coordinator, and Medical Assistant, to improve HEDIS and STARs scores. The Clinical Quality LPN performs a wide variety of duties and is responsible for driving clinical relationships and engagement with providers, patients, and pharmacies with a goal of improving health, well-being, and quality performance. This position is accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS and STARs gap closures. This role develops a comprehensive, provider-specific plan to increase their physician practice performance and improve their outcomes. If you are located in New Orleans, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities Run/pull/prioritize/distribute Quality and Med Adherence reports for all Quality Contract Payors Analyzes data collected and makes recommendations for process improvements Assist in the development and implementation of new policies and procedures designed to enhance quality care Perform Chart reviews to identify open gap measures Communicate with Clinical Team on open gaps Available resource for Clinical questions from Clinical Quality Administrative Coordinator Perform Med Adherence Calls Maintain Quality reports for each provider Perform initial and follow-up calls to patients for open gap measures Review/interpret internal medical records/data to determine whether there is documentation that medical services were rendered to close Quality Gaps Manipulate and leverage multiple databases/Electronic Medical Records applications to sort, search, and enter information Identify incomplete/inconsistent information in medical records and label missing measures/metrics/concerns 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. Required Qualifications Current and unrestricted Louisiana LPN License 2+ years of HEDIS and STARs measures experience 2+ years of health care industry experience Proven solid computer skills required including knowledge of Microsoft Word, Excel, and EPIC Physical Demands/Working Conditions Must be able to lift 10-15 pounds and operate standard office equipment, computer, printer, fax and copier Must have dependable transportation and be able to travel periodically to all clinic locations Core Competencies Sets priorities for work assignments and uses initiative in completion of tasks Professionalism Flexible Goal oriented Independent Team Player Excellent with follow-through and completion Enjoys working with detail and organization Produces highly accurate work Able to meet deadlines Solid verbal and written communication skills Ability to interface with multiple levels of the medical profession Understanding of the healthcare industry All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
$5,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The RN Field Clinical Care Coordinator, you will be an essential element of an Integrated Care Model by relaying the pertinent information about the members' needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs. If you reside within a commutable distance to the Mystic Valley, MA and surrounding areas (Malden, Lynn, Cambridge, Somerville, Medford, Everett, Saugus, Reading, Peabody), you will have the flexibility to work telecommute* as you take on some tough challenges. This is a Field-based role. Expect to spend about 50% of your time in the field visiting our members in their homes or in long-term care facilities. You'll need to be flexible, adaptable and, above all, patient in all types of situations. Primary Responsibilities Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Assess, plan and implement care strategies that are individualized by patients and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members What Are The Reasons To Consider Working For UnitedHealth Group? Put It All Together - Competitive Base Pay, a Full And Comprehensive Benefit Program, Performance Rewards, And a Management Team Who Demonstrates Their Commitment To Your Success. Some Of Our Offerings Include Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays Medical Plan options along with participation in a Health Spending Account or a Health Saving account Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement Employee Discounts Employee Assistance Program Employee Referral Bonus Program Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) More information can be downloaded at: http://uhg.hr/uhgbenefits 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. Required Qualifications Current and unrestricted independent licensure as a Registered Nurse in the state of MA 2+ years of clinical experience Intermediate level of proficiency with MS Office, including Word, Excel and Outlook Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Ability to travel in assigned regions to visit members in their homes and/or other settings, including community centers, hospitals or providers' offices Access to reliable transportation & valid US driver's license Preferred Qualifications Bachelor's or master's degree in nursing Certified Care Manager (CCM) 1+ years of community case management experience coordinating care for individuals with complex needs Experience working in team-based care Background in Managed Care Ability to utilize an Electronic Medical Record or other electronic platforms Bilingual Physical Requirements Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members and/or providers Ability to transport equipment to and from field locations is needed for visits (ex. laptop, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. PLEASE NOTE** The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED
$5,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The RN Field Clinical Care Coordinator, you will be an essential element of an Integrated Care Model by relaying the pertinent information about the members' needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs. If you reside within the Bridgewater, MA and surrounding areas market, you will have the flexibility to work telecommute* as you take on some tough challenges. This is a Field-based role. Expect to spend at least 50% of your time in the field visiting our members in their homes or in long-term care facilities. You'll need to be flexible, adaptable and, above all, patient in all types of situations. Primary Responsibilities Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Assess, plan and implement care strategies that are individualized by patients and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members What Are The Reasons To Consider Working For UnitedHealth Group? Put It All Together - Competitive Base Pay, a Full And Comprehensive Benefit Program, Performance Rewards, And a Management Team Who Demonstrates Their Commitment To Your Success. Some Of Our Offerings Include Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays Medical Plan options along with participation in a Health Spending Account or a Health Saving account Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement Employee Discounts Employee Assistance Program Employee Referral Bonus Program Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) More information can be downloaded at: http://uhg.hr/uhgbenefits You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications Current and unrestricted independent licensure as a Registered Nurse for MA 2+ years of clinical experience Intermediate level of proficiency with MS Office, including Word, Excel, and Outlook Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Ability to travel in assigned regions to visit members in their homes and/or other settings, including community centers, hospitals or providers' offices Access to reliable transportation & valid US driver's license Preferred Qualifications Bachelor's or Master's Degree in Nursing Certified Care Manager (CCM) 1+ years of community case management experience coordinating care for individuals with complex needs Experience working in team-based care Background in Managed Care Ability to utilize an Electronic Medical Record or other electronic platforms Bilingual-Spanish, Khmer Physical Requirements Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members and/or providers Ability to transport equipment to and from field locations is needed for visits (ex. laptop, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. PLEASE NOTE** The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification). You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities Review medical records and verify if the requested service meets criteria Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits Review and interpret Plan language Coordinate reviews with the Medical Director Utilize clinical guidelines and criteria Accurately documenting determinations Adherence to all confidentiality regulations and agreements Hours M-F 8a-5p with alternating Saturdays Comfortable working mandatory overtime 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. Required Qualifications Active, unrestricted RN license in state of residence 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting Proficiency in Microsoft Office, Word, Outlook, and Internet applications Available M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday) Preferred Qualifications Bachelor of Science in Nursing 1+ years of experience using MCG and/or Medicare criteria 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience Appeals experience Proven excellent communication, interpersonal, problem-solving, and analytical skills All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits re subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. If you are located within Eastern Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST. Primary Responsibilities Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid Identify if additional information is required to process an appeal Ability to adapt to changes that require cross training on appeal types as they are identified Ability to work independently Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision on administrative nurse level cases Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities 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. Required Qualifications Current, valid, and unrestricted RN licensure in your state of residence 2+ years of clinical experience in an acute care or an outpatient setting 1+ years of direct experience within one (or more) of the following areas: Utilization Review Medicaid and/or Medicare appeals experience LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC Proven experience/understanding of billable services and claims in a managed care environment Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills Access to high-speed internet Ability to work 8-5 within EST (Eastern standard time zone) Preferred Qualifications 5+ years of Medical Appeal experience working with Medicare and Medicaid Solid coding experience or Certified Coder (CPC) All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
