Clinical Appeals RN - Commercial Plan (M-F)- Remote

UnitedHealth Group • Mesa, AZ

5h • Remote

About The Position

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. Please see requirements for the schedules.

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 Monday - Friday
• 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
• Analyzing claim adjustments and histories, and reviewing previous decisions
• Evaluate denied services in accordance with policies, benefit plans, federal and state regulations, and clinical criteria, rendering approvals when appropriate
• Summarize medical information for review by the Medical Director as needed

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees