[Hiring] Clinical Appeals RN @UnitedHealth Group

Role Description

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. as you take on some tough challenges. Please note this team has a schedule as follows - M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday).

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 documenting determinations
• Adherence to all confidentiality regulations and agreements
• Hours M-F 8a-5p with alternating Saturdays
• Comfortable working mandatory overtime

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 their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday)

Requirements

• Bachelor of Science in Nursing (Preferred)
• 1+ years of experience using MCG and/or Medicare criteria (Preferred)
• 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience (Preferred)
• Appeals experience (Preferred)
• Proven excellent communication, interpersonal, problem-solving, and analytical skills (Preferred)

Benefits

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

Company Description

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.

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.

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.