Clinical Claims Review Rn - Flexible Schedule
UnitedHealth Group (Chicago, Illinois)

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UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health. Ovations Administration provides general services to all Ovations business units. Departments within Ovations Administration include Business Planning, Communications, Finance and Accounting, Human Capital, Information Technology, Legal Affairs, Public Affairs and Regulatory Affairs. Ovations is a family of UnitedHealth Group businesses dedicated to improving the health and well-being of Americans ages 50 and older.   We’re looking for a motivated and independent RN with medical coding knowledge to join our Medical Claims Review team. As the Clinical Claims Review RN, you would conduct facility claims review that is focused on readmissions and medical necessity. This new role would give you the chance to take a break from direct patient care while enjoying flexible hours and the potential to telecommute with proven success in this position. The chosen candidate may work from our Chicago, IL; Eau Claire, WI; Omaha, NE or St. Louis, MO office. Take your nursing career in a new direction, and apply today.   Key responsibilities of the Clinical Claims Review RN include: Examining facility claims in regard to readmissions Determining medical necessity and appropriateness Collaborating with other team members to help determine payment Acting as the resource for readmissions and claims appeals Requirements include: A current, unrestricted RN license CPT, HCPCS and ICD-9 coding knowledge Proficiency in Microsoft Office suite Excellent verbal and written communication skills 

In addition, ideal assets include:

Clinical claims experience Experience working in a hospital setting Medicare reimbursement policy knowledge Experience supporting payment policy on the payer or provider side Coding certification A Bachelor’s degree  UnitedHealth Group offers a full range of comprehensive benefits to full-time and part-time employees, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.   Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.   UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.    Keywords: clinical claims review, rn, review rn, utilization review, concurrent review, nurse, registered nurse, nursing, telephonic, telephonic rn, clinical claims reviewer, icd 9 coding, medical coding, coding certification