Spanish bilingual and Hispanic jobs since 1997. Diversity job fairs since 2006. employers     login   |   register - post a job
Hispanic Diversity Recruitment - best jobs for hispanic, latino & bilingual (spanish & portuguese) jobseekers
HOME
    Log me in!   |   Site Map   |   Help   
 Bilingual Quality Letter Reviewer RN - Telecommute - Unspecified, California, United States

   
Job information
Posted by: UHG 
Hiring entity type: Other 
Work authorization: Existing work authorization required for United States
Position type: Direct Hire, Full-Time 
Compensation: ******
Benefits: See below
Relocation: Not specified 
Position functions: Operations - Quality
 
Travel: Unspecified 
Accept candidates: from anywhere 
Languages: Spanish - Fluent
 
Minimum education: See below 
Minimum years experience: See below 
Resumes accepted in: English
Cover letter: No cover letter requested
Job code: 720253305 / Latpro-3652178 
Date posted: Nov-30-2018
State, Zip: California, Zip not provided

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.

 

Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

 

Work schedule requirement is Monday through Friday with rotational Saturday  

9am to 6pm Pacific Time

10am - 7pm Mountain Time

 

Rotational Saturday (every other weekend)

6am to 3pm Pacific Time

7am to 4pm Mountain Time

 

 

 

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
  • Ability to work independently or in a team environment  
  • The applicant should possess a high attention to detail, exceptional documentation abilities, and organizational skills

Required Qualifications:

  • RN license
  • Proven analytical and problem solving skills while managing multiple tasks simultaneously
  • Demonstrated excellent written and verbal communication skills
  • Proven ability to meet critical deadlines consistently, while completing tasks accurately
  • Proven ability to handle multiple tasks simultaneously by working independently, as well as part of a team, in a fast paced environment
  • Knowledge of State and Federal Regulations
  • Excellent computer skills with direct experience in Microsoft Office, Word and Excel
  • Ability to work a Monday through Friday work schedule which includes a rotational Saturday every other weekend
  • Bilingual in English and Spanish for reading, speaking and writing

Preferred Qualifications:

  • Managed care experience or experience with a regulatory or accredited body strongly preferred

 

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

 

 *All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.


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. 

 

 

Job Keywords: Bilingual, RN, Quality reviewer, benefits, contracts, telecommute, telecommuting, telecommuter, work from home, remote



Requirements

See job description.

 

UHG requires you to fill in their on-line form which will open in a different window.

Enter your email address and click 'Apply':
       Apply
  Prefer not to enter your email?