[Hiring] Clinical Appeals RN @UnitedHealth Group

Role Description

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. This role will require the ability to work on Saturday either in a traditional 5-day work week schedule or working 4-10 hour shifts but MUST be able to work until 5pm in residing time zone.

• Conducts reviews of member and provider appeals
• Analyzes claim adjustment and claim history
• Reviews history of previous reviews
• Reviews denied services in conjunction with policies and procedures, benefit plans, federal and state regulations, and clinical criteria to render approval when appropriate
• Extrapolates and summarizes medical information for review by Medical Director, as needed
• Balances the need to produce high quality work with meeting timeframes and production goals

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 review
• Utilization Management, pre-authorization, concurrent review or appeals experience
• Solid computer skills including proficiency in Microsoft Office Word, Outlook, and Internet applications
• Ability to access multiple computer platforms
• Access to install secure high-speed internet (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) and able to be secured to maintain Protected Health Information (PHI) and/or Protected Information (PI)
• Ability to work on Saturday either in a traditional 5-day work week schedule or working 4-10 hour shifts
• Ability to work until 5pm in residing time zone

Preferred Qualifications

• Medical Coding experience/knowledge
• Experience using Interqual
• Experience with the following systems: UNET, iCUE/HSR, ATS, ETS or Cirrus
• Experience analyzing medical records, benefit plans, medical policies and other various criteria
• Demonstrated ability to work independently with solid self-discipline and time management skills
• Demonstrated excellent communication, interpersonal, problem-solving, and analytical skills

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment

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.