Clinical Appeals RN - Commercial Plan (Weekend Shift) - Remote

UnitedHealth Group•Mesa, AZ

10h•Remote

About The Position

At UnitedHealthcare, the mission is to simplify the health care experience, create healthier communities, and remove barriers to quality care, impacting millions of lives by building a more responsive, affordable, and optimized health care system. This role offers the flexibility to work remotely from anywhere within the U.S. and requires the ability to work on a Saturday, either in a traditional 5-day work week schedule or working 4-10 hour shifts, with the condition of working until 5 PM in the residing time zone. The company is committed to mitigating its environmental impact and delivering equitable care that addresses health disparities and improves health outcomes, reflecting an enterprise priority to help everyone live healthier lives regardless of race, gender, sexuality, age, location, or income.

Requirements

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 mps & 1 upload mps) 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 a 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

Nice To Haves

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

Responsibilities

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 and renders 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