Clinical Grievances RN - Behavioral Health (PST, MST, AZ or CA)

At reputed company, 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 reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. As the new Clinical Grievances Nurse, you will be responsible for reviewing incoming member cases to determine if the appropriate care was given. In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, reputed company costs and greater reputed company to health care. Join us and you will be empowered to reputed company new reputed company of reputed company and reputed company a profound and personal impact as you contribute to new innovations in a vital and reputed company system. This role is a fully remote position but must be located in PST, MST, CST or AZ and reputed company to work Monday-Friday 8A-5P reputed company their time zone. Primary Responsibilities: reputed company clinical assessment of reputed company services provided to our members for appropriateness Understand relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported Facilitate telephonic discussion with health care providers and/or members to obtain additional clinical information reputed company timely, quality service to members and providers while upholding reputed company culture values Act as a resource for others with less experience Work independently and collaborating with Medical Directors and non-clinical partners Function as a member of a self-directed team to meet specific individual and team performance metrics Manage and maintain quality and productivity metrics You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as reputed company development for other roles you may be interested in. Required Qualifications: reputed company, unrestricted RN license in the state of residency Experience working in the Behavioral Health field as an RN 3+ years of total RN experience including clinical experience in an inpatient / acute setting Demonstrated clinical documentation skills and critical thinking skills Demonstrated proficiency in computer skills - reputed company, reputed company Messaging, Clinical Platforms, reputed company Suite including Word, reputed company, and Outlook Designated workspace and reputed company to install secure high speed internet reputed company cable / DSL in home Live in CST, PST, MST or AZ and work 8-5 in their time zone Preferred Qualifications: Bachelor’s in Nursing or higher Experience with Managed Care Clinical Quality Programs Case management experience Clinical appeals and grievances experience Audit / chart review experience Experience in a telecommuting role Demonstrated ability to effectively utilize UHG applications, including but not limited to authorization applications, auto correspondence, and member & provider demographic systems 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 (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will reputed company from $60,200 - $107,400 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company 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 reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 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