Clinical Claims Reviewer Lvn - Ca Remote

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

Position in this function is responsible for activities associated with retrospective claims reviews. Follows all retro review processes and meets all regulatory requirements. Consistently exhibits behavior and communication skills demonstrating Optum’s superior customer service, including quality, care, and concern with every internal and external customer.

If you are located in CA, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Performing a retrospective review of claims received for care and services in both the inpatient and outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients’ health plan benefits
• Conducts clinical reviews utilizing basic nursing knowledge, experience, and skills, as well as various managed care guidelines and departmental policy and procedures to ensure appropriate utilization of resources and patient quality outcomes
• Collaborates with care management and utilization management teams to ensure timely awareness of any process updates or changes occur routinely
• Ensures productivity targets, turnaround times are met
• Exhibits behavior and communication skills that demonstrate commitment to superior patient care, patient experience and patient outcomes
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Attends all departmental meetings and huddles as assigned
• Reports/communicates findings to the Claims department Manager / Physician Reviewer / or department VP in a timely manner
• Performs additional duties as assigned

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.

Required Qualifications:

• Graduation from an accredited school of Nursing
• Current California LVN license
• 1+ years of recent clinical experience working as an LVN/LPN
• Computer literate
• Demonstrated ability to work with multiple computer platforms simultaneous
• Demonstrated ability to make sound, independent judgments, and act professionally under pressure

Preferred Qualification:

• Care management, utilization review or discharge planning, Claims reviewer experience

California Residents Only: The hourly range for this role is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment