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.
Welcome to a challenging yet fulfilling way to help improve the lives of our members. The Clinical Appeals RN reviews member appeals denied at the utilization review level. You will communicate with members, utilize clinical guidelines, and work with medical directors to obtain positive outcomes for our members. We offer the latest tools and an intensive training program to prepare you for completing member appeals.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances)
Clinical Interface/Liaison (clinical problem solver with facilities, providers, resolution of issues concerning members, program definition and clarification)
Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits)
Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
Generally work is self-directed and not prescribed
Works with less structured, more complex issues
Solves moderately complex problems and/or conducts moderately complex analyses
Translates concepts into practice
Assesses and interprets customer needs and requirements
Identifies solutions to non-standard requests and problems
Works with minimal guidance; seeks guidance on only the most complex tasks
Provides explanations and information to others on difficult issues
Coaches, provides feedback, and guides others
Acts as a resource for others with less experience
The successful candidate in this role must bring solid analytical, organizational and communication skills
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, valid and unrestricted RN licensure in your state of residence
5+ years of clinical experience in an acute care or an outpatient setting
1+ years of Utilization Review or Medical Appeal Review experience
Solid Microsoft Office proficiency (Word, Adobe, Excel & Outlook) with experience filtering, building pivot tables, etc.
Access to high-speed internet
Located in one of these time zones and able to work Monday – Friday and business hours of 9am – 6pm if in CST, 8am – 5pm if in MST or 7am – 4pm if in PST
Preferred Qualifications:
Undergraduate degree
3+ years of Utilization Review experience
1+ years of experience in Background in Appeals and Grievances
Experience working in a Managed Care environment
Experience working in HSR/ICUE
Experience working in Doc360
ICD10 and CPT coding experience
Experience in a telephonic role
*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 all 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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