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RN Quality Letter Reviewer - Bilingual - Telecommute

UnitedHealth Group


Location:
San Antonio, TX
Date:
08/15/2017
2017-08-152017-09-13
Job Code:
1771687
Apply on the Company Site
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Job Details


RN Quality Letter Reviewer - Bilingual - Telecommute(Job Number:724648)
Description

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm) 
 
Ensuring that the Adverse Letters comply with all applicable State and Federal laws and consent decrees, as well as the applicable accrediting regulatory review agencies, including but not limited to CMS, NCQA, HIPAA, and all UHC policies and procedures as applicable.
 
**Work hours are Wednesday through Sunday 8am to 5pm.**
 
Primary Responsibilities:
  • Coordinates internal reviews on denial letters to determine compliance with contractual and regulatory requirements of the State and Federal programs, while reviewing for efficiencies and effectiveness of procedures
  • Performs internal Quality Control reviews on processes and activities while developing recommendations for improvement
  • Serves as a catalyst for implementing an appropriate risk assessment process designed to identify and correct deficiencies
  • Assists with the coordination of external audits and reviews conducted by our clients or contracting organizations
  • Maintain extensive knowledge of regulatory and applicable accrediting body requirements becoming a Compliance resource for the team
  • Proficient in interpreting benefits, contracts, and medical policy
  • Review denial notice issued by the National Letter team to ensure accuracy and compliance, as well as providing recommendations for improvement, as needed
  • Interact effectively with other departments
  • Maintain knowledge of State rules, contracts and Federal legislation / regulations as well as UHG guidelines
  • Establish and maintain good working relationships throughout the company to support goals and objectives
  • Demonstrate flexibility, availability and dependability to conform to position responsibilities

 

Job Clinical Administration
Primary Location US-TX-San Antonio
Other Location 
Organization Clin Support & Notifications
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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