Talent.com
Clinical Claims Review RN - Remote
Clinical Claims Review RN - RemoteUnitedHealth Group • Las Vegas, NV, United States
Clinical Claims Review RN - Remote

Clinical Claims Review RN - Remote

UnitedHealth Group • Las Vegas, NV, United States
[job_card.variable_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
  • [filters.remote]
[job_card.job_description]

At UnitedHealthcare, 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Under direct supervision of the Manager and Supervisors, Clinical Claims Review, conducts retrospective reviews for appropriateness of diagnostic procedures, inpatient, ambulatory, emergency room, and evaluation & management services, coding levels, etc., utilizing standardized criteria, protocols, and guidelines.

This RN will train and provide coverage for the Medical Adjudication and Coding Units in Clinical Claims Review.

If you reside within a commutable distance from the Las Vegas, NV area, you will have the flexibility to work remotely

  • as you take on some tough challenges.

Primary Responsibilities :

  • Provide support to all units within Claims to ensure all clinical components are met for CMS, NCQA, URAC, DOL, DOI, and all other State and Federal entities
  • Identify business priorities and necessary processes to triage and deliver work
  • Use appropriate business metrics (e.g. case turnaround time, productivity) and applicable processes / tools to optimize decisions and clinical outcomes
  • Review assigned claims (e.g. ER, inpatient, diagnostic procedures) to evaluate medical necessity and determine appropriate levels of care and site of service
  • Maintain incoming pended claims, electronic inquiries and medical records work queue
  • Identify information missing from clinical documentation; request additional clinical documentation as appropriate
  • Make determinations per relevant protocols (e.g., deny, return to claims system, designate as inappropriate referral, proceed with clinical or non-clinical research)
  • Prepare claims for medical director review by completing summary and attaching all pertinent medical information.
  • Interpret codes and determine coding accuracy
  • Use available resources to further interpret coding accuracy
  • Identify relevant information needed to make clinical determination
  • Review other approved sources of clinical information and use data for making clinical determinations (e.g., previous diagnoses, authorizations / denials)
  • Participate in various special projects as assigned
  • Attend assigned meetings relating to clinical reviews and other aspects of job function
  • Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, company & departmental confidentiality guidelines
  • Candidate must be available to complete 3-6 week onsite training.
  • 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 :

  • Current, unrestricted RN license for the state of Nevada
  • 2+ years of nursing experience in clinical claims review or utilization review
  • 1+ years of acute clinical nursing experience
  • Proficiency with Microsoft Word, Excel and Outlook
  • Preferred Qualifications :

  • Bachelor's degree
  • CPC certification
  • Knowledge of managed care delivery system concepts such as HMO / PPO
  • Knowledge of evidenced based and standardized criteria such as InterQual
  • Knowledge of CPT, and ICD-10 coding
  • Broad knowledge of medical conditions, procedures and management
  • Demonstrated ability to learn and differentiate between company products and the benefits
  • All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
  • 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 (all benefits are subject to eligibility requirements). No matter where or when you begin 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 comply with all minimum wage laws as applicable.

    At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe 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 experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

    UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, 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.

    UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

    [job_alerts.create_a_job]

    Clinical Claim Review Rn • Las Vegas, NV, United States

    [internal_linking.related_jobs]
    TurboTax Virtual Customer Care Associate

    TurboTax Virtual Customer Care Associate

    TurboTax • Henderson, Nevada
    [job_card.full_time]
    Work from home with TurboTax Product Expert.Get a $405 Certification bonus³.Work from home & set your own flexible schedule between 8am EST and 12am midnight EST Monday to Sunday⁴.Earn an ...[show_more]
    [last_updated.last_updated_1_day] • [promoted]
    Remote Customer Care Associate

    Remote Customer Care Associate

    TurboTax • Henderson, Nevada
    [filters.remote]
    [job_card.full_time]
    Work from home with TurboTax Product Expert.Get a $405 Certification bonus³.Work from home & set your own flexible schedule between 8am EST and 12am midnight EST Monday to Sunday⁴.Earn an ...[show_more]
    [last_updated.last_updated_1_day] • [promoted]
    Travel Radiation Therapist - $2,133 to $2,364 per week in Reno, NV

    Travel Radiation Therapist - $2,133 to $2,364 per week in Reno, NV

    AlliedTravelNetwork • Henderson, Nevada, US
    [job_card.full_time]
    AlliedTravelNetwork is working with LRS Healthcare to find a qualified Radiation Therapist in Reno, Nevada, 89502!.Ready to start your next travel adventure? LRS Healthcare offers a full benefits p...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Nurse - RN - Cath Lab - $2901.6 / Week - Hiring Now

    Travel Nurse - RN - Cath Lab - $2901.6 / Week - Hiring Now

    CrossMed Healthcare • Henderson, NV, US
    [job_card.full_time]
    CrossMed Healthcare is seeking an experienced Cath Lab Registered Nurse for an exciting Travel Nursing job in Henderson, NV. Shift : Inquire Start Date : ASAP Duration : 13 weeks Pay : $2901.At CrossMed...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Physical Therapist (PT) - $1,738 to $1,927 per week in Las Vegas, NV

    Travel Physical Therapist (PT) - $1,738 to $1,927 per week in Las Vegas, NV

    AlliedTravelNetwork • Henderson, Nevada, US
    [job_card.full_time]
    AlliedTravelNetwork is working with LRS Healthcare to find a qualified Physical Therapist (PT) in Las Vegas, Nevada, 89104!. Ready to start your next travel adventure? LRS Healthcare offers a full b...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Physical Therapist (PT) - $2,159 per week in North Las Vegas, NV

    Travel Physical Therapist (PT) - $2,159 per week in North Las Vegas, NV

    Triage Staffing LLC • Henderson, Nevada, US
    [job_card.full_time]
    Travel Rehab : Physical Therapy North Las Vegas.Location : North Las Vegas.Shift Details : 8H Days (12 : 00 AM-12 : 00 PM). Length : 13 WEEKS 13 weeks.Apply for specific facility details.[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Radiation Therapist - $2,596 to $2,796 per week in Reno, NV

    Travel Radiation Therapist - $2,596 to $2,796 per week in Reno, NV

    Titan Medical Group • Henderson, Nevada, US
    [job_card.full_time]
    ARRT(T) / BCLS / BLS - American Heart Association.Titan Medical is looking for travelers to fill a Travel Radiation Therapist position for a 13 week assignment in Reno, NV! Call Titan for additional de...[show_more]
    [last_updated.last_updated_1_day] • [promoted]
    Travel Nurse - RN - Cath Lab - $3412.4 / Week - Hiring Now

    Travel Nurse - RN - Cath Lab - $3412.4 / Week - Hiring Now

    FlexCare • Henderson, NV, US
    [job_card.full_time]
    FlexCare is seeking an experienced Cath Lab Registered Nurse for an exciting Travel Nursing job in Henderson, NV.Shift : 4x10 hr flex Start Date : ASAP Duration : 13 weeks Pay : $3412.Why Clinicians Ch...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel Physical Therapist (PT) - $1,738 to $1,927 per week in North Las Vegas, NV

    Travel Physical Therapist (PT) - $1,738 to $1,927 per week in North Las Vegas, NV

    LRS Healthcare • Henderson, Nevada, US
    [job_card.full_time]
    Ready to start your next travel adventure? LRS Healthcare offers a full benefits package, 24 / 7 support, and a responsive, traveler-first culture. What are you waiting for? Apply today!.Valid license...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Radiation Therapist - $2,133 to $2,364 per week in Reno, NV

    Travel Radiation Therapist - $2,133 to $2,364 per week in Reno, NV

    LRS Healthcare • Henderson, Nevada, US
    [job_card.full_time]
    Ready to start your next travel adventure? LRS Healthcare offers a full benefits package, 24 / 7 support, and a responsive, traveler-first culture. What are you waiting for? Apply today!.Valid license...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Nurse - RN - LD - Labor and Delivery - $2285.72 / Week

    Travel Nurse - RN - LD - Labor and Delivery - $2285.72 / Week

    FlexCare • Henderson, NV, US
    [job_card.full_time]
    FlexCare is seeking an experienced Labor and Delivery Registered Nurse for an exciting Travel Nursing job in Henderson, NV. Shift : 3x12 hr nights Start Date : 01 / 12 / 2026 Duration : 13 weeks Pay : $2285...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Nurse RN - Telemetry - $2,077 per week in Reno, NV

    Travel Nurse RN - Telemetry - $2,077 per week in Reno, NV

    TravelNurseSource • Henderson, Nevada, US
    [job_card.full_time]
    TravelNurseSource is working with Medical Solutions to find a qualified Telemetry RN in Reno, Nevada, 89521!.A facility in Reno, NV is seeking its next amazing RN (Registered Nurse) to work in Tele...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Physical Therapist (PT) - $2,096 per week in North Las Vegas, NV

    Travel Physical Therapist (PT) - $2,096 per week in North Las Vegas, NV

    Medical Solutions • Henderson, Nevada, US
    [job_card.full_time]
    A facility in North Las Vegas, NV is seeking its next amazing PT (Physical Therapist).Read on if this sounds like your perfect fit!. Nurses and allied healthcare professionals are in high demand nat...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Physical Therapist (PT) - $2,047 to $2,243 per week in Las Vegas, NV

    Travel Physical Therapist (PT) - $2,047 to $2,243 per week in Las Vegas, NV

    AMN Healthcare Allied • Henderson, Nevada, US
    [job_card.full_time]
    Job Description & Requirements.Physical Therapist - Outpatient - (PT) .StartDate : 1 / 5 / 2026 Available Shifts : 8 D Pay Rate : $2046. Travel Physical Therapist jobs in Las Vegas, NV offer you the ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Physical Therapist (PT) - $1,806 to $2,176 per week in Las Vegas, NV

    Travel Physical Therapist (PT) - $1,806 to $2,176 per week in Las Vegas, NV

    Fusion Medical Staffing • Henderson, Nevada, US
    [job_card.full_time]
    Travel Physical Therapist (PT).Fusion Medical Staffing is seeking a skilled Physical Therapist for a 13-week travel assignment in Las Vegas, Nevada. As a member of our team, you'll have the opportun...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Radiation Therapist - $2,865 per week in Reno, NV

    Travel Radiation Therapist - $2,865 per week in Reno, NV

    Medical Solutions • Henderson, Nevada, US
    [job_card.full_time]
    A facility in Reno, NV is seeking its next amazing Radiation Therapist.Read on if this sounds like your perfect fit!.Nurses and allied healthcare professionals are in high demand nationwide, and ou...[show_more]
    [last_updated.last_updated_1_day] • [promoted]
    Travel Nurse - RN - LD - Labor and Delivery - $2347 / Week

    Travel Nurse - RN - LD - Labor and Delivery - $2347 / Week

    Stability Healthcare • Henderson, NV, US
    [job_card.full_time]
    Stability Healthcare is seeking an experienced Labor and Delivery Registered Nurse for an exciting Travel Nursing job in Henderson, NV. Shift : 3x12 hr nights Start Date : 01 / 12 / 2026 Duration : 13 week...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Physical Therapist (PT) - $2,040 per week in North Las Vegas, NV

    Travel Physical Therapist (PT) - $2,040 per week in North Las Vegas, NV

    Core Medical Group • Henderson, Nevada, US
    [job_card.full_time]
    Client in NV seeking Physical Therapist.We are looking for a healthcare professional who is ready to provide exceptional patient care in this contract / travel role. Contract / travel assignments are ty...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]