Clinical Claim Review RN - Medical Disability - Remote ID-13544

About the position

The Clinical Claim Review RN position at UnitedHealth Group involves evaluating and processing patient health information to determine outcomes for various medical and specialty exams. The role requires conducting clinical reviews of examination documentation, test results, and assessments, while collaborating with providers to ensure compliance with regulatory and contractual requirements. The position is remote, allowing flexibility to work from anywhere in the U.S., and includes responsibilities such as identifying behavioral health issues and providing exemplary service to providers.

Virtual Assistant, $45/hr, Remote, No Experience, Night Job Data Entry, $40/hr, Remote, Night Shift, College Student Job Data Entry, $45/hr, Remote, Night Job, No Degree Data Entry, $40/hr, No Experience, Remote, Weekend Job Remote Moderator, No Degree, $35/hr, Evening, Weekend Job Data Entry, $50/hr, Remote, Evening Job, College Student Remote Phone Support, $45/hr, Night Job, College Student Virtual Assistant, $42/hr, Remote, Weekend, No Degree Data Entry, Remote, $40/hr, Evening Job, No Degree Phone Job, $35/hr, Remote, No Degree, Part-Time, Weekend Remote Customer Support, $45/hr, Part-Time, College Student Virtual Assistant, $50/hr, Remote, Part-Time, Evening Job Data Entry, Remote, $40/hr, Night Shift, No Degree Data Entry, $50/hr, Night Shift, No Degree, Remote Job Live Chat Support, $42/hr, Weekend, Remote, No Degree Remote Moderator, $40/hr, Part-Time, Weekend, No Degree Data Entry, $50/hr, Night Shift, No Degree, Remote Job Remote Customer Support, $45/hr, No Experience, Part-Time Virtual Assistant, $40/hr, Remote, Weekend, No Degree Live Chat Support, $45/hr, Part-Time, Remote, No Degree Weekend Data Entry, $40/hr, Remote, No Experience Data Entry, $35/hr, Night Job, No Degree, Remote Phone Support, $50/hr, Weekend, Remote, No Experience Virtual Assistant, No Experience, $42/hr, Remote, Part-Time Remote Customer Support, $42/hr, Weekend, No Experience Customer Support, $40/hr, Remote, Evening, No Experience Remote Moderator, $42/hr, Weekend, No Experience Required Customer Support, $42/hr, Weekend Job, Remote, No Degree Remote Phone Job, $50/hr, College Student, Night Shift Data Entry, No Experience, $50/hr, Remote, College Student Data Entry, $35/hr, Remote, Evening Job, College Student Entry Level Phone Job, $42/hr, Remote, No Degree Required Remote Phone Job, $40/hr, No Degree, College Student Friendly Remote Moderator, $42/hr, Weekend, No Experience Required Remote Phone Job, $45/hr, No Degree, College Student Friendly Virtual Assistant, $40/hr, Remote, Weekend, No Degree Live Chat Support, Remote, $42/hr, Night Shift, College Student Evening Virtual Assistant, Remote, $45/hr, No Experience Remote Phone Job, $40/hr, Part-Time, No Degree Required Virtual Assistant, $40/hr, Remote, Weekend, Entry Level Virtual Assistant, Remote, $40/hr, Evening, No Experience Phone Support, Remote, $40/hr, Evening/Night Shift Virtual Assistant, $42/hr, Evening, Remote, College Student Remote Phone Job, $35/hr, College Student, Night Shift Customer Support, No Degree, $40/hr, Remote, Weekend Job Remote Customer Support, $45/hr, Part-Time, College Student Phone Job, $40/hr, Remote, Night Shift, No Degree Data Entry, $40/hr, Remote, Night Job, No Degree Data Entry, Remote, $40/hr, Night Shift, No Degree Phone Support, $35/hr, Weekend, Remote, No Experience Phone Job, $45/hr, Remote, Night Shift, No Degree Customer Support, No Degree, $40/hr, Remote, Weekend Job Data Entry, $40/hr, Remote, Night Shift, College Student Job Remote Live Chat, $42/hr, Weekend, No Degree, Part-Time Virtual Assistant, $40/hr, Remote, No Experience, Night Job Customer Support, $42/hr, Weekend Job, Remote, No Degree Live Chat Support, $40/hr, Part-Time, Remote, No Degree Live Chat Support, $40/hr, Part-Time, Remote, No Degree Virtual Assistant, $40/hr, No Experience, Remote, Night Job Phone Job, $35/hr, Remote, Part-Time, College Student Customer Support, $40/hr, Remote, Evening, No Experience Remote Customer Support, $40/hr, Weekend, No Experience Remote Moderator, No Degree, $50/hr, Evening, Weekend Job Virtual Assistant, $42/hr, Remote, No Experience, Evening Part-Time Data Entry, $40/hr, Remote, College Student Friendly Customer Support, No Degree, $40/hr, Remote, Weekend Job Live Chat Support, Remote, $42/hr, Night Shift, College Student Phone Support, Remote, $35/hr, No Experience, Part-Time Virtual Assistant, $42/hr, Remote, Weekend, Entry Level Phone Job, $50/hr, Remote, Part-Time, College Student Data Entry, $50/hr, Night Job, No Degree, Remote Data Entry, No Experience, $35/hr, Remote, College Student Virtual Assistant, Remote, $50/hr, Part-Time, Night Shift Remote Moderator, $40/hr, No Degree, Weekend Job, Part-Time Remote Live Chat, $42/hr, Weekend, No Degree, Part-Time Part-Time Data Entry, $40/hr, Remote, College Student Friendly Remote Data Entry, $40/hr, Part-Time, No Degree Required Data Entry, Remote, $40/hr, Evening Job, No Degree Phone Support, Remote, $35/hr, No Experience, Part-Time Live Chat Support, $40/hr, Weekend, Remote, No Degree Remote Data Entry, $35/hr, No Experience, Evening/Night Job Live Chat Support, $45/hr, Weekend, Remote, College Student Remote Moderator, $50/hr, No Degree, Weekend, Part-Time Remote Live Chat, $50/hr, Part-Time, Evening/Night Job Phone Job, $45/hr, Remote, Night Shift, No Degree Remote Moderator, No Degree, $35/hr, Evening, Weekend Job Remote Virtual Assistant, $40/hr, Evening, Part-Time Job Remote Moderator, $42/hr, Weekend, No Experience Required Data Entry, $35/hr, Remote, Evening Job, College Student Remote Data Entry, $50/hr, No Experience, Evening/Night Job Virtual Assistant, $42/hr, Remote, No Experience, Evening Phone Support, $35/hr, Weekend, Remote, No Experience Remote Data Entry, $50/hr, No Experience, Evening/Night Job Phone Job, $50/hr, Remote, No Degree, Part-Time, Weekend Data Entry, No Degree, $40/hr, Part-Time, Remote Job Remote Data Entry, $45/hr, No Degree, Night Shift Data Entry, $40/hr, Remote, Night Job, No Degree Data Entry, $35/hr, Night Job, No Degree, Remote Live Chat Support, $40/hr, Part-Time, Remote, No Degree Remote Customer Support, $42/hr, Weekend, No Experience Weekend Data Entry, $40/hr, Remote, No Experience Remote Live Chat, $35/hr, Part-Time, Evening/Night Job Data Entry, Remote, $40/hr, Evening Job, No Degree Remote Live Chat, $42/hr, Weekend, No Degree, Part-Time

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 provider with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork
  • Answer calls that come into the Clinical Operations Review queue regarding 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 intervention process
  • Complete system generated tasks to process exam documentation
  • Interface via telephone and e-mail with contracted providers in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol

Requirements

  • Accredited Associate's Degree in Nursing (ADN) OR Bachelor's Degree in Nursing (BSN)
  • Current RN license in your state of residency
  • 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 Microsoft Office programs and database experience
  • Ability to work rotating weekends (approximately every 8 weeks)
  • Distraction-free, dedicated space in home for home office
  • Access to high-speed internet (cable, fiber optic)

Nice-to-haves

  • Experience in an Intensive Care Unit or Emergency Room
  • Prior authorization, utilization management/review experience
  • Experience reviewing medical disability claims
  • Knowledge or experience in clinical quality assurance
  • Auditing and compliance
  • Education of clinical staff
  • Clinical documentation improvement
  • Clinical experience in Neurological, Cardiovascular or Respiratory units
  • ISO 9001 standards
  • Healthcare regulatory and accreditation standards
  • Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
  • Military experience
  • Proven ability to collaborate with providers to ensure quality patient outcomes

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...