UnitedHealth Group

Clinical Grievances RN - Missouri - Telecommute

Posted on: 5 Apr 2021

Kansas City, MO

Job Description

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 and help people live healthier lives while doing your life's best work.(sm)

Positions in this function require RN licensure or LSW with current unrestricted licensure in applicable state and may require certification based on role and grade level. Provides clinical support for responding to quality of care grievances and may provide quality intervention services. Process includes analyzing, reviewing and evaluating quality of care concerns in compliance with state and federally mandated turn-around-times and process requirements.

If you are located in the state of Missouri, you will have the flexibility to telecommute* as you take on some tough challenges.

**Monday - Friday, 8am - 5pm**

Primary Responsibilities:

* Assess and interprets customer needs and requirements
* Identify solutions to non-standard requests and problems
* Solve moderately complex problems and / or conducts moderately complex analyses
* Work with minimal guidance; seeks guidance on only the most complex tasks
* Translate concepts into practice
* Provide explanations and information to others on difficult issue
* Coach, provide feedback, and guide others
* Acts as a resource for others with less experience
* Work with minimal guidance, using critical thinking 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:

* Bachelor's degree in Social Work or Nursing
* Residency in the state of MO and an active unrestricted licensure in nursing or LCSW license
* 2+ years of clinical experience in an acute or outpatient facility
* Proficient with MS Office Products to include Excel, Word and Outlook
* Access to high speed internet and a designated workspace in the home
* Experience in Healthcare Quality concurrent Grievances
* Prior field-based work experience
* 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. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

* Experience in Healthcare Quality
* Experience with arranging community resources

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

*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: Social Work, Nursing, clinical, outpatient, LCSW, RN, MS Office, Excel, Word, Outlook, healthcare quality, grievances, community resources, Kansas City, St. Louis, Springfield, Columbia, Independence, Missouri

UnitedHealth Group

Hopkins, MN

UnitedHealth Group Incorporated operates as a diversified health care company in the United States. It operates through four segments: UnitedHealthcare, OptumHealth, OptumInsight, and OptumRx. The UnitedHealthcare segment offers consumer-oriented health benefit plans and services for national employers, public sector employers, mid-sized employers, small businesses, and individuals; health and well-being services to individuals age 50 and older, addressing their needs for preventive and acute health care services, as well as services dealing with chronic disease and other specialized issues for older individuals; and Medicaid plans, Children’s Health Insurance Program, and health care programs; and health and dental benefits.

The OptumHealth segment provides access to networks of care provider specialists, health management services, care delivery, consumer engagement, and financial services. This segment serves individuals through programs offered by employers, payers, government entities, and directly with the care delivery systems.

The OptumInsight segment offers software and information products, advisory consulting arrangements, and services outsourcing contracts to hospital systems, physicians, health plans, governments, life sciences companies, and other organizations. The OptumRx segment provides pharmacy care services and programs, including retail network contracting, home delivery, specialty and compounding pharmacy, and purchasing and clinical, as well as develops programs in areas, such as step therapy, formulary management, drug adherence, and disease/drug therapy management. UnitedHealth Group Incorporated was founded in 1974 and is based in Minnetonka, Minnesota.

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