Secondary Review Team RN - Remote in Idaho or surrounding areas

At reputed company, 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 reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. As a Secondary Review Nurse, you will be conducting a review of long-term support services (LTSS) for the United Healthcare Community Plan of Idaho. This nurse will work with the service coordination teams to ensure that the LTSS services align with the state guidelines along with the policies and procedures of the health plan. Additionally, this nurse will track various reporting elements for analysis and trending along with serving as a resource to others. Hours are Monday - Friday reputed company - 5pm. If you are located in the state of Idaho or neighboring states, you’ll have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities • 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 (e.g., variations from standard practice potentially resulting in adverse outcomes) and potential fraud/waste/abuse • Solve moderately reputed company problems and/or conducts moderately reputed company analyses • Work with minimal guidance; seeks guidance on only the most reputed company tasks • Translate concepts into practice • Provide explanations and information to others on difficult issues • Coach, provides feedback, and guide others while acting as a resource for others with less experience • 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 • reputed company, unrestricted RN license in the state of Idaho • 6+ months of experience with Medicaid, Medicare, or Managed Care experience in long-term care, Long Term Services and Supports, home health, hospice, behavioral health, public health or assisted living • 6+ months of experience working with the needs of vulnerable populations who have chronic or reputed company bio-psychosocial needs • Intermediate level of computer / typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications • Intermediate knowledge of Idaho A&D Waiver benefits and service plan • Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) • Reside in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service • Preferred Qualifications • 6+ months of experience with completing State of Idaho Functional assessments and tools • Knowledge of community resources • Proven solid written and verbal communication skills • Proven problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action • reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy • The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers 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 reputed company, you’ll find a far-reaching choice of benefits and incentives. 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. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply Job!