Optum

SSBV Clinical Claim Review RN

Posted on

August 15, 2025

Job Type

Full-Time

Role Type

Clinical Operations

License

RN

State License

Minnesota

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Help & Resources

Company Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Job Description

Let's face it, no industry is moving faster than health care. And no organization is better positioned to lead health care forward than UnitedHealthcare, part of the UnitedHealth Group family of businesses. As a SSBV Clinical Claims Review RN, you can put your skills and talents to work. This is a multifaceted role that is highly rewarding. It feels great to have autonomy, though there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact on our members. And at the same time, you'll be challenged by a demanding case load in a rapidly changing, production-driven environment. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Requirements

Required Qualifications: High School Diploma/GED (or higher) Current and unrestricted RN license in the state of residency 5+ years of clinical documentation experience 3+ years of experience as an RN, including inpatient/acute setting Intermediate level of proficiency in Microsoft Office (to include Microsoft Excel and One Note) Intermediate level of proficiency in writing Designated home office workspace with access to install secure high-speed internet via cable/DSL Preferred Qualifications: Undergraduate or higher degree A background in utilization review for an insurance company or experience in case management Familiarity with InterQual and/or MCG Care Guidelines Critical thinking skills All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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Responsibilities

Perform administrative reviews of short stay inpatient hospital claims in accordance with Federal, State and client specific requirements Responsible for documentation of all determinations Maintain accurate use of screening criteria

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