supervisor clinical admin Registered NurseUnitedHealth Group

Job Description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Position in this function is responsible for reviewing denied medical claims from medical providers through the medical records of the patient, UnitedHealth Care Guidelines, Milliman Care Guidelines, InterQual, and their medical judgement. 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.
Primary Responsibilities:
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)
Coordinates, supervises and for the daily activities of business support, technical or production team or unit
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
Undergraduate degree or equivalent experience
USRN or PHRN