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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 equitable. Ready to make 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 Kansas population.  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.  The Secondary Review team consists of nurses and technicians within the plan. Hours are Monday – Friday 8am – 5pm.

If you are located within the state of Kansas, you will 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 complex problems and/or conduct moderately complex analyses
• Work with minimal guidance; seeks guidance on only the most complex 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

What are the reasons to consider working for UnitedHealth Group?   Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 in the state of Kansas
• 2+ years of experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
• 1+ years of experience working with people receiving services on one of the homes and community-based waivers in KS
• 1+ years of 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
• 1+ years of computer experience, including experience with email, internet research, enter/retrieve data in electronic clinical records, use of online calendars and other software applications

Preferred Qualifications:

• Knowledge of community resources
• Strong written and verbal communication skills
• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

*All Telecommuters 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 $28.94 to $51.83 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.