Clinical Appeals RN - Remote in EST or CST Time Zone id-2463

December 27, 2024

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.

If you are located within Eastern Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST.

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Primary Responsibilities

Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid
Identify if additional information is required to process an appeal
Ability to adapt to changes that require cross training on appeal types as they are identified
Ability to work independently
Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision on administrative nurse level cases
Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities

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
2+ years of clinical experience in an acute care or an outpatient setting
1+ years of direct experience within one (or more) of the following areas:
- Utilization Review
- Medicaid and/or Medicare appeals experience
- LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC
Proven experience/understanding of billable services and claims in a managed care environment
Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills
Access to high-speed internet
Ability to work 8-5 within EST (Eastern standard time zone)

Preferred Qualifications

5+ years of Medical Appeal experience working with Medicare and Medicaid
Solid coding experience or Certified Coder (CPC)
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Connecticut, Maryland, New Jersey, New York, Rhode Island, Washington, D.C. Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. 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.

Clinical Appeals RN - Remote in EST or CST Time Zone id-2463

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