Global insurance Clinical Care Manager - Bilingual Japanese RN - Remote

apartment UnitedHealthcare location_onTampa, FL, US

$72,800 - $130,000 / YEAR

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 Global insurance Clinical Care Manager - Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States.

This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs.

Primary Responsibilities

A GI CCM must consider both US and international care standards and regulatory guidelines. They must be able to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to perform the clinical review
Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches
The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims

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

Registered Nurse with an active unrestricted United States license
Must be bilingual in Japanese and English, with strong verbal and written communication skills
3+ years of experience in medical-surgical inpatient acute care
Experience with working in collaboration with Medical Director to review care plans make recommendations. Ability to advocate on behalf of the member's needs while considering contractual limitations
Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals
Proven communication skills at all levels
Proven ability to be flexible and display a positive attitude
Proven solid problem-solving, organizational and crisis management skills
Proven ability to function confidently and efficiently in fast paced work environment
Proven ability to foster team cohesion in an international virtual environment
Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations
Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members
Proven advanced software skills with ability to work in multiple platforms with clinical case reviews
Proven advanced skills with Microsoft Office - Excel, Word
Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs

Preferred Qualifications

Bachelor's degree
2+ years of experience in utilization management or case management in a managed care or hospital environment
Experience in international healthcare and/or air medical transport
Experience in discharge planning and/or chart review
International travel experience
Demonstrated familiarity with InterQual criteria guidelines
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 salary for this role will range from $72,800 to $130,000 annually 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.

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