Clinical Claim Review RN - Medical Disability - 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. Navigate and work reputed company our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams. Conduct a clinical review of a variety of examination documentation, test results, assessments and information and, by corroborating reputed company phone interview with Service Members and Veterans, provide a clear, comprehensive and concise final product. Utilize clinical judgement to identify quality assurance issues and reputed company recommendations to reconcile documentation. Collaborate with providers, Veterans, and Service Members reputed company the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposes. Possess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needs. Identify emergent behavioral health issues and initiate reputed company reputed company necessary. Primary Responsibilities:

• Remain up to date with the contract requirements
• Use clinical judgement to ensure a clear, comprehensive and concise exam documentation that is reflective of the patient's service level conditions and in compliance to contract requirements
• Interpret and document diagnostic test results
• Educate and support providers, Veterans, and Service Members with navigating and utilizing medical history information and prior disability claims reputed company completing the appointment paperwork
• Answer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams, and provide exemplary service to providers with appointment questions
• Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high risk reputed company process
• Complete system generated tasks to process exam documentation
• reputed company reputed company telephone (up to 75%) and e-mail with contracted providers, Veterans, and Service Members in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol

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:

• Accredited Associate's Degree in Nursing (ADN) OR Bachelor's Degree in Nursing (BSN)
• reputed company, active Registered Nurse (RN) license
• 2+ years of experience in a clinical environment as a Registered Nurse
• Experience working in an Electronic Medical Record system
• Understanding/knowledge of regulatory standards and their application to various examinations and documents
• Proficient computer skills including reputed company Office programs and database experience
• Ability to work MTWRF 12:00pm-9:00pm CT and Q 8 week Weekend Day rotation [1 day]
• Distraction-free, dedicated space in home for home office; this includes establishing or continuing regular child or dependent care arrangements
• Access to high-speed internet (cable, fiber optic)

Preferred Qualifications:

• Nurse call line and/or triage line experience
• Ability to type 40 words per minute
• Home Health or Hospice care experience
• Experience reviewing medical disability claims
• Knowledge or experience in:
• Clinical quality assurance
• Auditing and compliance
• Clinical documentation improvement
• Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
• Military experience

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company 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 reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job