At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
We are seeking a dedicated and experienced professional to join our team as an IFP. In this role, you will be responsible for conducting thorough reviews of member and provider appeals, analyzing claim adjustments and histories, and reviewing previous decisions. You will also evaluate denied services in accordance with policies, benefit plans, federal and state regulations, and clinical criteria, rendering approvals when appropriate. Additionally, you will summarize medical information for review by the Medical Director as needed, ensuring a balance between high-quality work and meeting production goals.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Please see requirements for the schedules.
Primary Responsibilities:
Conducting thorough reviews of member and provider appeals
Analyzing claim adjustments and histories, and reviewing previous decisions
Evaluate denied services in accordance with policies, benefit plans, federal and state regulations, and clinical criteria, rendering approvals when appropriate
Summarize medical information for review by the Medical Director as needed
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:
Active, unrestricted RN license in state of residence
5+ years of clinical experience as an RN, including in an acute, inpatient hospital setting
Experience applying benefits and criteria to clinical reviews
Utilization Management, pre-authorization, concurrent review, or appeals experience
Proficiency in Microsoft Office Word, Outlook, and Internet applications
Ability to access multiple computer platforms
Secure high-speed internet access (minimum speed 5 download Mbps & 1 upload Mbps) via cable/DSL in home (wireless/cell phone provider, satellite, microwave, etc. does NOT meet this requirement)
Designated quiet workspace in your home, separated from non-workspace areas
Ability to work until 6pm in residing time zone
Ability to work a on Saturday either in a traditional 5 day work week schedule or working 4-10 hour shifts
Preferred Qualifications:
Bachelor of Science in Nursing
Experience using Interqual
Familiarity with systems such as Facets, iCUE/HSR, ATS, Doc360
Experience analyzing medical records, benefit plans, medical policies, and other criteria
Demonstrated ability to work independently with solid self-discipline and time management skills
Demonstrated excellent communication, interpersonal, problem-solving, and analytical skills
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al 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.
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.
UnitedHealth Group
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