Secondary Review Nurse - Remote in Kansas

Company Overview

At United Healthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start caring, connecting and growing together.

As a Secondary Review Nurse, you will conduct a review of long‑term support services (LTSS) for the United Healthcare Community Plan of Kansas population. You will work with service‑coordination teams to ensure that LTSS services align with state guidelines, the health plan’s policies, and procedures. You will track reporting elements for analysis and trending and serve as a resource to others.

The Secondary Review team includes nurses and technicians. Hours are Monday‑Friday, 8 am – 5 pm. If you are located within Kansas, you may work remotely.

• Review technical metrics, specifications, and measures.
• Evaluate documentation of functional assessment against form instructions.
• Review and compare assessments to prior assessments for changes.
• Provide recommendations to service coordination on assessment opportunities.
• Follow relevant regulatory guidelines, policies and procedures in reviewing clinical documentation (e.g., HEDIS, Clinical Practice Guidelines, HCC).
• Review relevant HEDIS specifications to guide chart review.
• Interpret and summarize medical records/data to address quality of care questions.
• Review provider responses to reports/findings and correlate with medical records.
• Verify necessary documentation is included in medical records.
• Maintain HIPAA requirements for sharing minimum necessary information.
• Identify potential quality of care issues and potential fraud, waste or abuse.
• Solve moderately complex problems and/or conduct moderately complex analyses.
• Work with minimal guidance; seek guidance only on the most complex tasks.
• Translate concepts into practice.
• Provide explanations and information to others on difficult issues.
• Coach, provide feedback, and guide others while acting as a resource for those with less experience.

• Paid Time Off, accruing with first pay period plus 8 paid holidays.
• Medical plan options with Health Spending Account or Health Savings Account.
• Dental, Vision, Life & AD&D insurance and short‑term and long‑term disability coverage.
• 401(k) savings plan, employee stock purchase plan.
• Education reimbursement.
• Employee discounts.
• Employee assistance program.
• Employee referral bonus program.
• Voluntary benefits (pet insurance, legal insurance, LTC insurance, etc.).
• More information can be downloaded at (Use the "Apply for this Job" box below)..

• Current, unrestricted RN license in the state of Kansas.
• 2+ years of experience working with vulnerable populations who have chronic or complex biopsychosocial needs.
• 1+ year of experience working with people receiving services on one of the homes and community‑based waivers in Kansas.
• 1+ year of Medicaid, Medicare, or managed‑care experience in long‑term care, LTSS, home health, hospice, behavioral health, public health or assisted living.
• 1+ year of computer experience, including email, internet research, data entry and retrieval in electronic clinical records, online calendars and other software applications.

• Knowledge of community resources.
• Strong written and verbal communication skills.
• Problem‑solving skills; ability to systematically analyze problems, draw conclusions and devise appropriate courses of action.

* All telecommuters must adhere to United Health Group’s Telecommuter Policy.

Pay ranges from $28.94 to $51.83 per hour for full‑time employment, depending on location, education, experience, certifications, and other factors. In addition to salary, we offer benefits, incentive and recognition programs, equity stock purchase, and 401(k) contribution (subject to eligibility). We comply with all applicable minimum‑wage laws.

At United Health Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe that everyone, regardless of race, gender, sexuality, age, location, and income, deserves the opportunity to live their healthiest life. We are committed to addressing health disparities and improving outcomes.

United Health Group is an Equal Employment Opportunity employer under applicable law. Qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

United Health Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.