Clinical Grievances RN - Remote in PST

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.

As a Clinical Grievances Nurse, you will be responsible for reviewing incoming retrospective cases to determine if the appropriate care was given along with current cases to ensure the members immediate needs are being addressed. In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. If you are able to work PST hours, you'll enjoy the flexibility to work remotely* from anywhere in the U.S. as you take on some tough challenges. The working hours for this role are Monday - Friday, 8 am - 5pm PST or CST (Whichever time zone you are within).

Perform clinical assessment of healthcare services provided to our members for appropriateness Understand relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported Receives cases from the QIS non- clinical team and reviews them against required clinical information, assessing for appropriateness and consulting with a Medical Director Document relevant chronology of case review and provide rationale for severity level, descriptor codes, and any applicable Improvement Action Plan (IAP) implemented Facilitate telephonic discussion with health care providers and/or members to obtain additional clinical information Provide timely, quality service to members and providers while upholding UnitedHealthcare culture values Act as a resource for others with less experience Work independently and collaborating with Medical Directors and non-clinical partners Function as a member of a self-directed team to meet specific individual and team performance metrics Manage and maintain quality and productivity metrics 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.