Current jobs related to SCA Clinical Claim Review RN - La Crosse, Wisconsin - UnitedHealth Group
-
Clinical Research Coordinator
7 days ago
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeJob Summary:The Clinical Research Coordinator provides research coordination and support to the principal investigators, patients, and Gundersen Health System staff for projects that support the mission and objectives of Gundersen Medical Foundation. This role meets the expectations of a professional employee.Main Responsibilities:1. Collaborate with...
-
Clinical Manager
2 weeks ago
La Crosse, Wisconsin, United States Aveanna Healthcare Full timeJob Title: Clinical Manager - Home Health RNJob Summary:Aveanna Healthcare is seeking a highly skilled and experienced Clinical Manager - Home Health RN to lead our clinical team in delivering high-quality patient care. As a Clinical Manager, you will be responsible for supervising clinical staff, ensuring compliance with regulatory requirements, and driving...
-
Clinical Manager
4 weeks ago
La Crosse, Wisconsin, United States Aveanna Healthcare Full timeJob Title: Clinical Manager - Home Health RNJob Summary:Aveanna Healthcare is seeking a highly skilled and experienced Clinical Manager - Home Health RN to lead our clinical team in delivering high-quality patient care. As a Clinical Manager, you will be responsible for overseeing the clinical programs, services, and employees of the agency, ensuring...
-
Clinical Manager
2 weeks ago
La Crosse, Wisconsin, United States Aveanna Healthcare Full timeJob Title: Clinical Manager - Home Health RNJob Summary:The Clinical Manager - Home Health RN is responsible for providing supervision and guidance to clinical staff working with high medical acuity clients and/or clients receiving extended non-licensed support services. This leader is responsible for ensuring that services are delivered according to...
-
RN Clinical Supervisor Emergency Department
2 weeks ago
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeJob Title: RN Clinical Supervisor EmergencyGundersen Lutheran Administrative is seeking a highly skilled RN Clinical Supervisor to join our Emergency Department team. As a key member of our leadership team, you will be responsible for overseeing the daily operations of the department, ensuring high-quality patient care, and driving a culture of service and...
-
Clinical Manager
2 months ago
La Crosse, Wisconsin, United States Aveanna Healthcare Full timeJob SummaryAveanna Healthcare is seeking a highly skilled and experienced Clinical Manager - Home Health RN to lead our clinical team in delivering high-quality patient care. As a key member of our leadership team, you will be responsible for overseeing the clinical operations of our home health division, ensuring compliance with regulatory requirements, and...
-
Clinical Research Coordinator
7 days ago
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeJob Description:The Clinical Research Coordinator provides research coordination and support to the principal investigators, patients, and Gundersen Health System staff for projects that support the mission and objectives of Gundersen Medical Foundation.Key responsibilities include preparing regulatory documents for submission to Research Committee and the...
-
RN Clinical Supervisor
3 weeks ago
La Crosse, Wisconsin, United States Gundersen Health System Full timeAbout the RoleGundersen Health System is seeking a highly skilled and experienced Clinical Nurse Supervisor to join our Surgical Department. As a Clinical Nurse Supervisor, you will play a vital role in ensuring the delivery of high-quality patient care and services in our fast-paced and dynamic environment.Key ResponsibilitiesAssist in carrying out the...
-
RN Utilization Management Specialist
4 weeks ago
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeJob Title: RN Utilization Management SpecialistGundersen Lutheran Administrative is seeking a skilled RN Utilization Management Specialist to join our team. As a key member of our healthcare team, you will play a vital role in ensuring that patients receive the necessary care and services.Job Summary:The RN Utilization Management Specialist will be...
-
RN Utilization Management Specialist
4 weeks ago
La Crosse, Wisconsin, United States Gundersen Health System Full timeJob Title: RN Utilization Management SpecialistGundersen Health System is seeking a skilled Registered Nurse to join our Utilization Management team. As a RN Utilization Management Specialist, you will play a critical role in ensuring that patients receive the necessary care and services to achieve optimal health outcomes.Job Summary:The RN Utilization...
-
RN Clinical Supervisor
4 weeks ago
La Crosse, Wisconsin, United States Gundersen Health System Full timeAbout the RoleGundersen Health System is seeking a highly skilled and experienced RN Clinical Supervisor to join our Emergency Department team. As a key member of our leadership team, you will be responsible for overseeing the daily operations of the department, ensuring high-quality patient care, and driving a culture of service and patient satisfaction.Key...
-
RN Clinical Supervisor Emergency Department
1 month ago
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeJob SummaryGundersen Lutheran Administrative is seeking a skilled RN Clinical Supervisor to lead our Emergency Department team. As a key member of our leadership team, you will be responsible for overseeing the delivery of high-quality patient care, managing a team of nurses, EMTs, and paramedics, and driving process improvements to enhance patient...
-
RN Clinical Supervisor Emergency Leadership
7 days ago
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeLead with Compassion and ExpertiseGundersen Lutheran Administrative is seeking a dedicated and compassionate RN Clinical Supervisor to join our Emergency Department team. As a key leader, you will be responsible for overseeing the daily operations of our high-energy, patient-centered department, ensuring exceptional patient care and satisfaction.Key...
-
Clinical Manager Home Health RN
2 days ago
La Crosse, Wisconsin, United States Aveanna Healthcare Full timeJob SummaryThis challenging leadership position involves overseeing the clinical operations of our home healthcare team. As a Clinical Manager Home Health RN, you will be responsible for supervising a team of nurses and ensuring the delivery of high-quality patient care.Main Responsibilities:Lead and manage a team of clinical staff to provide exceptional...
-
Neurosurgery Clinic Nurse
2 weeks ago
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeJob Title: Registered Nurse for Neurosurgery ClinicJob Summary:Gundersen Health System is seeking a part-time Registered Nurse for our Neurosurgery Clinic. This is an excellent opportunity to work in a dynamic team environment and contribute to the delivery of high-quality patient care.Responsibilities:* Provide nursing care to patients undergoing...
-
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeJob Summary:We are seeking a strong leader to contribute to our mission by engaging, motivating, and driving a culture of service and patient satisfaction in our high-energy, patient-centered Emergency Department and Urgent Care. As a working clinical supervisor, you will be expected to provide patient care and oversee roughly 40 direct reports composed of...
-
Nurse Practitioner
1 week ago
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeJob Summary: Gundersen Health System is seeking a part-time Registered Nurse (RN) for our Pulmonary Clinic. This is an excellent opportunity to work in a dynamic environment while doing the work you love in the beautiful coulee region. Responsibilities: • Perform phone triage and med refills, coordinate referrals and transfers of care, provide patient...
-
Clinical Care Specialist
1 month ago
La Crosse, Wisconsin, United States US Tech Solutions Full timeJob Title: Clinical Care SpecialistUS Tech Solutions is seeking a skilled Clinical Care Specialist to join our team. As a Clinical Care Specialist, you will be responsible for providing direct and indirect patient care services under the pharmacist's independent authority to administer COVID-19 vaccinations.Key Responsibilities:Assess and administer COVID-19...
-
Pulmonary Clinic Nurse
2 weeks ago
La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full timeJob Summary:We are seeking a skilled Registered Nurse to join our Pulmonary Clinic team. As a key member of our healthcare team, you will be responsible for providing high-quality patient care and education to individuals with pulmonary conditions.Responsibilities:- Assess patients' physiological, emotional, and sociocultural status to develop a...
-
Clinical Assistant Professor
2 weeks ago
La Crosse, Wisconsin, United States University of Wisconsin La Crosse Full timeJob SummaryThe University of Wisconsin La Crosse is seeking a qualified individual to fill a full-time, 12-month instructional academic staff position in the Department of Health Professions. This position is available starting August 2024 and is a new position within our faculty.Job ResponsibilitiesThe successful candidate will be responsible for teaching...
SCA Clinical Claim Review RN
3 months ago
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.
Navigate and work within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams. Conduct a clinical review of a variety of examination documentation, test results, assessments and information to provide a clear, comprehensive and concise final product. Utilize clinical judgement to identify quality assurance issues and make recommendations to reconcile documentation. Collaborate with providers via the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposes. Possess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needs. Identify emergent behavioral health issues and initiate intervention when necessary.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Mountain or Pacific Time Zones Preferred
Primary Responsibilities:
- Remain up to date with the contract requirements
- Use clinical judgement to ensure a clear, comprehensive and concise exam documentation that is reflective of the patient's service level conditions and in compliance to contract requirements
- Interpret and document diagnostic test results
- Educate and support provider with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork
- Answer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams and provide exemplary service to providers with appointment questions
- Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high-risk intervention process
- Complete system generated tasks to process exam documentation
- Interface via telephone and e-mail with contracted providers in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol
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 provide development for other roles you may be interested in.
Required Qualifications:
- Accredited Associate's Degree in Nursing (ADN) (or higher)
- Current RN license in your state of residency
- 2+ years of experience in a clinical environment as a Registered Nurse
- 2+ years of experience working in an Electronic Medical Record system
- Intermediate level of proficiency with the ability to use clinical judgement to interpret test results
- Intermediate level of understanding with regulatory standards and their application to various examinations and documents
- Intermediate level of proficiency with general computer skills including Microsoft Office programs and database experience
- Ability to work 12:00PM - 9:00PM Central Standard Time with the ability to work 1 weekend day in a rotational 8 week schedule
Preferred Qualifications:
- Knowledge or experience in regards to: clinical quality assurance; auditing and compliance; education of clinical staff; Clinical Documentation Improvement; clinical experience with Neurological, Cardiovascular or Respiratory units; vision testing, audio testing, reviewing dental images; ISO 9001 standards, and/or other healthcare regulatory and accreditation standards
- Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
- Nurse call line and/or triage line experience
- Collaborating with providers to ensure quality patient outcomes
- Military experience
Soft Skills:
- Excellent verbal and written communication skills
- Analytical thinking and teamwork skills
- Ability to perform detailed work with a high degree of accuracy
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C Residents Only : The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C residents is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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 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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
