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Clinical Review Nurse Specialist, RN - Telecommute - Tampa, FL preferred

UnitedHealth Group

Tampa, FL
Job Code:
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Job Details

Clinical Review Nurse Specialist, RN - Telecommute - Tampa, FL preferred(Job Number:718057)

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 and help people live healthier lives while doing your life's best work.(sm)
The Clinical Review Nurse Specialist applies clinical knowledge and expertise with established clinical guidelines to provide clients with accurate and timely prospective, concurrent and retrospective clinical reviews for all home health referrals managed by PMSI/PMIs Home Health (Critical Care) and Clinical Services Department.   The Clinical Review Nurse Specialist interacts directly with discharge planners, home health operations, claims adjusters, and case managers to assess, plan and coordinate the execution of Home Health services and DME.
***This is a telecommute position, but candidates based in the Tampa, Florida area will be given preference***
Primary Responsibilities:
  • Positions in this function include RN roles (with current unrestricted licensure in applicable state) responsible for providing clinical expertise in any of the following areas
  • Clinical Interface/Liaison (clinical problem solver with facilities, providers, carriers; resolution of issues concerning members, benefit interpretation, program definition and clarification)
  • Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits)
  • Clinical Training (planning, coordinating, delivering and evaluating clinical training)
  • Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
  • Clinical Program Management (development, implementation and/or on-going management and administration of a clinical program(s). Provides strategic oversight and support, measurement standards and revisions as needed for delivery of programs focused on quality, affordability and outcomes.)
  • Reviews the work of others
  • Develops innovative approaches
  • Sought out as expert
  • Serves as a leader / mentor

Job Clinical Administration
Primary Location US-FL-Tampa
Other Location 
Organization OptumRx Workers Comp
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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