Top 490 Enfermería Jobs in Río Grande Pr

RN Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR
UnitedHealth Group —San Juan, PR
- Full-time
- RN License
- Pass drug screening
- Research
Nurse Care Manager I (NCLEX)
Elevance Health —San Juan, PR
- 8 hour shift
- Nursing
- RN License
- Bachelor of Science
- Employee stock purchase plan
- Paid holidays
Facultad de Enfermería
EDP University of Puerto Rico —Humacao, PR
- Full-time
Quick Apply
Enfermera/o
Grupo SEPI —San Juan, PR
- From $3,000 a month
- Full-time
- In-person
Quick Apply
4d
Profesor(a) Grado Bachillerato en Enfermería - LPN
NUC University —Río Grande, PR
- Part-time
Quick Apply
Clinical Review Specialist
TPIS —San Juan, PR
- $55,000 - $65,000 a year
- Monday to Friday
- Spanish
- Nursing
- RN License
Quick Apply
4d
Director of Nursing
NeoMed Center Inc —Gurabo, PR
- $24.69 - $26.07 an hour
- Extended hours
- CPR Certification
- Nursing
- PALS Certification
- Free parking
- Continuing education credits
Quick Apply
Profesor(a) Bachillerato en Ciencias de Enfermería (RN a BSN)
NUC University —Río Grande, PR
- Part-time
Quick Apply
Profesor(a) Grado Asociado en Enfermería
NUC University —Río Grande, PR
- Part-time
Quick Apply
Nursing Informatics Specialist
Infomedika, Inc —San Juan, PR
- $36,000 - $42,000 a year
- Full-time
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse (Home Visit & Telehealth)
Alura Workforce Solutions —San Juan, PR
- $44 - $48 an hour
- Part-time
- Patient monitoring
- RN License
- Reliable transportation
Quick Apply
3d
Bilingual Call Center Nurse
Insight Communications —San Juan, PR
- 8 hour shift
- Spanish
- Nursing
- English
Quick Apply
HP3 Care Managers
APS Health Care PR —San Juan, PR
- Part-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
4d
Profesor(a) Bachillerato en Ciencias de Enfermería - SG
NUC University —Río Grande, PR
- Part-time
Quick Apply
Profesor(a) MA en Ciencias en Enfermería - Educación
NUC University —Río Grande, PR
- Part-time
Quick Apply
Profesor(a) MA Enfermería - Medico Quirúrgico - Administración
NUC University —Río Grande, PR
- Part-time
Quick Apply
OASIS Reviewer
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Enfermera Escolar
COLEGIO MARIA AUXILIADORA DE CAROLINA, PR, INC —Villa Carolina, PR
- From $1,500 a month
- Full-time
- Nursing
- In-person
- Associate's degree
- Health insurance
- Employee discount
Quick Apply
7d
Profesor(a) MA Enfermería - Medico Quirúrgico - Educación
NUC University —Río Grande, PR
- Part-time
Quick Apply
HP3 Care Manager
APS Health Care PR —San Juan, PR
Quick Apply

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RN Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR

UnitedHealth Group -
San Juan, PR

Apply Now

Job Details

Full-time

Qualifications

Foreign language proficiency
RN License
Productivity software

Full 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.

Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment.

Primary Responsibilities:

Clinical Case Reviews -75%
- Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported
- Maintain standards for productivity and accuracy. Standards are defined by the department
- Provide clear and concise clinical logic to the providers when necessary
- Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
- Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Investigate and pursue recoveries
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- Other internal customer correspondence and team needs - 15%
- Attend and provide feedback during monthly meetings with assigned internal customer department
- Provide continuous feedback on how to improve the department relationships with internal team members and departments
Continuing education - 10%
- Keep up required Coding Certificate and/or Nursing Licensure
- Complete compliance hours as required by the department

***ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION***

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:

Coding Certificate or Nursing Licensure, for example:
Puerto Rico Registered Nurse
Certified Professional Coder (CPC) + CPC A
Certified Inpatient Coder (CIC)
Certified Outpatient Auditor (COC)
Certified Professional Medical Auditor (CPMA)
Certified Coding Specialist (CCS)
Demonstrated proficiency with computers, including Microsoft Suite of products
Ability to observe an on-site work model
Willing or able to work from Monday to Friday, 40 hours per week during our business operating hours of 8am - 7pm ATL
Professional proficiency in both English and Spanish (Please note that an English proficiency assessment will be required for this position)

Preferred Qualifications:

Experience working with medical claims platforms
Medical record coding experience with experience in Evaluation and Management Services in the outpatient/office setting
Presentation or policy documentation experience
Proven knowledge of CMS and AMA coding rules specific to CPT, HCPCS
Proven knowledge of CMS Coverage, Federal and State Statues, Rules and Regulations
Proven knowledge of Medicaid/Medicare Reimbursement methodologies
Proven working knowledge of the healthcare insurance/managed care industry
Proven working knowledge of medical terminology and claim coding

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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enfermería jobs in río grande pr

RN Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR

Nurse Care Manager I (NCLEX)

Facultad de Enfermería

Enfermera/o

Profesor(a) Grado Bachillerato en Enfermería - LPN

Clinical Review Specialist

Director of Nursing

Profesor(a) Bachillerato en Ciencias de Enfermería (RN a BSN)

Profesor(a) Grado Asociado en Enfermería

Nursing Informatics Specialist

Registered Nurse (Home Visit & Telehealth)

Bilingual Call Center Nurse

HP3 Care Managers

Profesor(a) Bachillerato en Ciencias de Enfermería - SG

Profesor(a) MA en Ciencias en Enfermería - Educación

Profesor(a) MA Enfermería - Medico Quirúrgico - Administración

OASIS Reviewer

Enfermera Escolar

Profesor(a) MA Enfermería - Medico Quirúrgico - Educación

HP3 Care Manager

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