RN Quality Letter Reviewer – Bilingual Spanish – Telecommute

UnitedHealth Group
Published
March 31, 2021
Location
San Antonio, TX
Category
Job Type

Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The successful candidate will be ensuring that the Adverse Letters comply with all applicable State and Federal laws and consent decrees, as well as the applicable accrediting regulatory review agencies, including but not limited to CMS, NCQA, HIPAA, and all UHC policies and procedures as applicable.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Work schedule requirement is Monday through Friday:
9am - 6pm Pacific Time, 10am - 7pm Mountain Time

Primary Responsibilities:

  • Coordinates internal reviews on denial letters to determine compliance with contractual and regulatory requirements of the State and Federal programs, while reviewing for efficiencies and effectiveness of procedures
  • Performs internal Quality Control reviews on processes and activities while developing recommendations for improvement
  • Serves as a catalyst for implementing an appropriate risk assessment process designed to identify and correct deficiencies
  • Assists with the coordination of external audits and reviews conducted by our clients or contracting organizations
  • Maintain extensive knowledge of regulatory and applicable accrediting body requirements becoming a Compliance resource for the team
  • Proficient in interpreting benefits, contracts, and medical policy
  • Review denial notice issued by the National Letter team to ensure accuracy and compliance, as well as providing recommendations for improvement, as needed
  • Interact effectively with other departments
  • Maintain knowledge of State rules, contracts and Federal legislation/regulations as well as UHG guidelines
  • Establish and maintain good working relationships throughout the company to support goals and objectives
  • Demonstrate flexibility, availability and dependability to conform to position responsibilities
  • Ability to work independently or in a team environment

The applicant should possess a high attention to detail, exceptional documentation abilities, and organizational skills

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:

  • Active and unrestricted RN license in your state of residence
  • Bilingual English and Spanish. Must be able to read, write and speak Spanish and English
  • Proven analytical and problem solving skills and the ability to manage multiple tasks simultaneously
  • Demonstrated excellent written and verbal communication skills
  • Proven ability to meet critical deadlines consistently, while completing tasks accurately
  • Proven ability to handle multiple tasks simultaneously by working independently, as well as part of a team, in a fast paced environment
  • Knowledge of State and Federal Regulations
  • Excellent computer skills with direct experience in Microsoft Office, Word and Excel
  • Ability to work a Monday through Friday work schedule which includes a rotational Saturday every other weekend
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener.  When in a UnitedHealth Group building, employees are required to wear a mask in common areas.  In addition, employee must comply with any state and local masking orders

Preferred Qualifications:

  • Managed care experience or experience with a regulatory or accredited body 

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

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

Job Keywords: Bilingual, RN, Quality Reviewer, Benefits, Contracts, Registered Nurse, RN, Nurse, Letter Reviewer, Letter Review RN, Auditor, Appeals And Grievances RN, Telecommute, Telecommuting, Telecommuter, Work From Home, Remote, Phoenix, Seattle, Denver, Las Vegas, San Antonio, Phoenix, Portland, AZ, WA, NV, CO, OR, TX

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