Secondary Review Nurse - Remote in Kansas

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. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

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

The Secondary Review team consists of nurses and technicians within the plan. Hours are Monday - Friday 8am - 5pm.

If you are located within the state of Kansas
, you will have the flexibility to work remotely as you take on some tough challenges.

• Review technical metrics/specifications/measures
• Evaluate documentation of Functional Assessment, compare to adherence to form instructions
• Review and compare to prior assessment for changes
• Provide recommendations to SC completing assessment if areas of opportunity exist
• 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
• Review/interpret/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
• Based on review of clinical data/documentation, identify potential quality of care issues and potential fraud/waste/abuse
• Solve moderately complex problems and/or conduct moderately complex analyses
• Work with minimal guidance; seek guidance on only 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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to salary, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution are offered (subject to eligibility).

• Paid Time Off accrued from the first pay period plus 8 paid holidays
• Medical Plan options with Health Spending Account or Health Savings Account
• Dental, Vision, Life & AD&D Insurance, 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)./uhgbenefits

• Current, unrestricted RN license in the state of Kansas
• 2+ years of experience working with the needs of vulnerable populations with chronic or complex bio-psychosocial needs
• 1+ years of experience with homes and community-based waivers in KS
• 1+ years of Medicaid, Medicare, or Managed Care experience in long-term care or related fields
• 1+ years of computer experience, including email, internet research, electronic clinical records, online calendars, and other software applications

• Knowledge of community resources
• Strong written and verbal communication skills
• Problem solving skills with the ability to analyze problems and devise appropriate actions
• All Telecommuters will be required to adhere to United Health Group s Telecommuter Policy

United Health Group is an Equal Employment Opportunity employer and a drug-free workplace. We comply with all applicable laws regarding equal employment opportunity and drug testing as a condition of employment.

2024 United Health Group