Nurse Auditor, Implants and Drugs

UnitedHealth Group
September 22, 2022
Philadelphia, PA
Job Type


Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)  

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

The Nurse Auditor, Implants and Drugs will work remotely and independently but also collaborate as part of a specialized team of auditors, office support staff and management. They will be performing quality checks on all completed work for thoroughness and accuracy. The Nurse Auditor will be submitting completed work in a timely manner with attention to client, state, and contractual timeframes. The successful individual will have the ability to adapt to a changing and growing environment. 

Primary Responsibilities:

  • Review operative reports, medication administration records, hospital billing and manufacturer invoices to determine if the billing and payment for implants and high-cost drugs are supported by the records, and payment or anticipated payment is accurate according to the contract terms between the payor and the facility
  • Communicate decisions regarding contract and reimbursement determinations
  • Speak with health care facilities to explain audit result and obtain additional clinical information as needed.
  • This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. Strong computer and software navigation skills are critical. You should also be strongly patient-focused and adaptable to changes.

What are the reasons to consider working for UnitedHealth Group?   Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
  • More information can be downloaded at:

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

  • Current and active Registered Nurse license
  • Bachelor’s degree (or higher) in Nursing or 4 plus years equivalent nursing experience  
  • 2 plus years of experience performing audits to verify accurate documentation and reimbursement 
  • 1 plus year experience in the area of conflict resolution and ability to identify, define and explain day-to-day problems and solutions 
  • Intermediate computer literacy experience with MS Word, (create, edit, save documents) and Outlook (email and calendar management), also able to navigate on the web through multiple applications
  • Intermediate proficiency in Excel
  • A designated home work space with access to install secure high-speed internet via cable/DSL and access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)

Preferred Qualifications

  • 2 plus years of Acute care experience
  • Basic knowledge of CPT, ICD10, HCPCS, NUBC or other coding structures
  • Operating Room nursing or Infusion experience
  • Experience calculating drug costs and verify accurate unit billing

Soft Skills:

  • Strong oral and written communication skills
  • Demonstrated effective organizational skills and scheduling skills as observed in day-to-day work
  • Excellent interpersonal and problem-solving skills
  • Attention to detail, as observed in day-to-day work
  • Excellent time management and prioritization skills
  • Must demonstrate flexibility, ability to follow through on all tasks in a timely fashion, good attention to detail and a willingness to learn
  • Strong team player, initiative in achieving individual and team goals, and team building skills
  • Demonstrates initiative in achieving individual, team, and organizational goals and objectives

Join a team that's committed to shaping the future of health care. Help improve life for millions as you do your life's best work.SM

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment   

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)   

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.   

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $26.15 to $46.63. The salary range for Connecticut / Nevada residents is $28.85 to $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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. 

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: nurse, RN, audit, auditor, telecommute, remote, work from home, WFH, WAH, drug, operating room, hiring immediately, Clinical Claim Review RN-CVT , Nurse Auditor, Implants, #green

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