Clinical Reviewer

Welcome to UnitedHealth Group – a company dedicated to improving the lives of individuals and communities through innovative healthcare solutions. We are currently seeking a highly skilled Clinical Reviewer to join our team. As a Clinical Reviewer, you will play a crucial role in ensuring the quality and accuracy of medical records, while also maintaining compliance with regulatory standards. We are looking for a detail-oriented and compassionate individual with a strong background in healthcare and a passion for making a positive impact on patient outcomes. If you are ready to be a part of a dynamic and purpose-driven organization, we encourage you to apply for this exciting opportunity.

1. Review and analyze medical records to ensure accuracy and quality of documentation.
2. Identify any discrepancies or missing information in medical records and work with healthcare providers to obtain necessary information.
3. Verify compliance with regulatory standards and internal policies and procedures.
4. Conduct thorough and detailed assessments of medical records to determine appropriate level of care and treatment.
5. Collaborate with healthcare providers to ensure proper coding and billing practices.
6. Communicate effectively with healthcare providers and other team members to resolve any issues or discrepancies.
7. Maintain confidentiality and adhere to HIPAA regulations at all times.
8. Utilize clinical knowledge and expertise to make informed decisions about medical record information.
9. Stay up-to-date on industry standards and best practices to ensure high-quality reviews.
10. Participate in training and educational opportunities to continuously improve skills and knowledge.
11. Provide clear and concise documentation of all review findings and recommendations.
12. Work collaboratively with other departments and team members to improve processes and procedures.
13. Maintain a positive and professional attitude while working in a fast-paced environment.
14. Uphold the company's mission and values of improving healthcare outcomes for individuals and communities.
15. Serve as a resource for colleagues and healthcare providers, providing guidance and support as needed.
16. Adhere to productivity and quality standards set by the organization.
17. Contribute to the development and implementation of new processes and procedures to improve efficiency and accuracy.
18. Act as an advocate for patients, ensuring their needs are met and their rights are protected.
19. Complete all assigned tasks and projects within designated timelines.
20. Continuously seek opportunities for personal and professional development to enhance job performance.

According to JobzMall, the average salary range for a Clinical Reviewer in Philadelphia, PA, USA is $61,000 - $95,000 per year. This can vary depending on factors such as level of experience, education, and specific job responsibilities.

UnitedHealth Group Incorporated is an American for-profit managed health care company based in Minnetonka, Minnesota. UnitedHealth Group, Inc. provides health care coverage, software and data consultancy services. It operates through the following segments: UnitedHealthcare, OptumHealth, OptumInsight, and OptumRx. The UnitedHealthcare segment utilizes Optum's capabilities to help coordinate patient care, improve affordability of medical care, analyze cost trends, manage pharmacy benefits, work with care providers more effectively, and create a simpler consumer experience.