UnitedHealthcare
Clinical Appeals RN - Remote - M-F working alternating Saturdays
UnitedHealthcare, Cypress, California, United States, 90630
Clinical Appeals RN - Remote - M-F working alternating Saturdays
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.
The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification).
You’ll enjoy the flexibility to work remotely
from anywhere within the U.S.
Primary Responsibilities
Review medical records and verify if the requested service meets criteria
Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits
Review and interpret Plan language
Coordinate reviews with the Medical Director
Utilize clinical guidelines and criteria
Accurately document determinations
Adhere to all confidentiality regulations and agreements
Work hours M-F 8a-5p with alternating Saturdays
Comfortable with mandatory overtime
You will 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
2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting
Proficiency in Microsoft Office, Word, Outlook, and Internet applications
Available M-F, 8:00-4:30 in your time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday)
Preferred Qualifications
Bachelor of Science in Nursing
1+ years of experience using MCG and/or Medicare criteria
1+ years of Utilization Management, pre‑authorization, concurrent review or appeals experience
Appeals experience
Proven excellent communication, interpersonal, problem‑solving, and analytical skills
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.
Application Deadline This posting will remain open for a minimum of 2 business days or until a sufficient candidate pool has been collected. The job posting may close early due to volume of applicants.
Equal Employment Opportunity 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.
Seniority level Entry level
Employment type Full‑time
Job function Health Care Provider
Industries Nursing Homes and Residential Care Facilities
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The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification).
You’ll enjoy the flexibility to work remotely
from anywhere within the U.S.
Primary Responsibilities
Review medical records and verify if the requested service meets criteria
Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits
Review and interpret Plan language
Coordinate reviews with the Medical Director
Utilize clinical guidelines and criteria
Accurately document determinations
Adhere to all confidentiality regulations and agreements
Work hours M-F 8a-5p with alternating Saturdays
Comfortable with mandatory overtime
You will 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
2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting
Proficiency in Microsoft Office, Word, Outlook, and Internet applications
Available M-F, 8:00-4:30 in your time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday)
Preferred Qualifications
Bachelor of Science in Nursing
1+ years of experience using MCG and/or Medicare criteria
1+ years of Utilization Management, pre‑authorization, concurrent review or appeals experience
Appeals experience
Proven excellent communication, interpersonal, problem‑solving, and analytical skills
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.
Application Deadline This posting will remain open for a minimum of 2 business days or until a sufficient candidate pool has been collected. The job posting may close early due to volume of applicants.
Equal Employment Opportunity 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.
Seniority level Entry level
Employment type Full‑time
Job function Health Care Provider
Industries Nursing Homes and Residential Care Facilities
#J-18808-Ljbffr