Clinical Grievances RN - Remote in CA

About This Role

As a Clinical Grievances Nurse, you will review incoming retrospective cases to determine if appropriate care was given and ensure members' immediate needs are addressed. This role is ideal for those who can work PST hours and are looking for a remote opportunity.

Highlights

• Pay : $29 - $52/hour
• Location : Mesa, AZ
• Department/Unit : Clinical Grievances
• Schedule : Full Time, Day shift
• Residency : Must live in the state of CA

What You'll Do

• Perform clinical assessment of healthcare services provided to members for appropriateness
• Understand relevant state and federal grievance and peer review requirements
• Receive cases from the QIS non-clinical team and review against required clinical information
• Document relevant chronology of case review and provide rationale for severity level
• Facilitate telephonic discussions with healthcare providers and/or members
• Provide timely, quality service to members and providers
• Act as a resource for others with less experience
• Work independently and collaborate with Medical Directors and non-clinical partners
• Function as a member of a self-directed team to meet performance metrics
• Manage and maintain quality and productivity metrics

Requirements

Education

• RN license in the state of residency required

Experience

• 3+ years of total RN experience including recent clinical experience in an inpatient/acute setting

Licenses & Certifications

• Current, unrestricted RN license in the state of CA

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They aim to help people live healthier lives and make the health system work better for everyone.