Sr Clinical Admin Nurse

Location
Pittsburgh, Pennsylvania
Posted
Sep 23, 2011
Closes
Sep 28, 2011
Ref
364018
Sector
Nursing
Organization Type
Corporate
Contract Type
Employee
Hours
Full Time



Description

Licensed RN, familiar with medical necessity programs and Milliman Care Guidelines 


Positions in this function include RN (with current licensure) role responsible for providing clinical expertise in any of the following areas:

Clinical Appeals (analyzing, reviewing and evaluating appeals, quality of care concerns, grievances)

Clinical Interface/Liaison (clinical problem solver with facilities, providers, carriers; resolution of issues concerning members, benefit interpretation, program definition and clarification)

Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits)

Clinical Training (planning, coordinating, delivering and evaluating clinical training)

Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)


- Generally work is self-directed and not prescribed.

- Works with less structured, more complex issues.

- Serves as a resource to others.


 

Qualifications

Requirements:

 

Current unrestricted RN licensure
Basic computer skills

Strong clinical skills

Medicare and Medicare experience a plus

Familiar with CareOne and Facets, Milliman criteria


UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus.

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

 

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. In addition, employees in certain positions are subject to random drug testing.

 





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