Clinical Appeals RN (M&R) - Remote (M-F 8-5)
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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims.
Requirements
- Undergraduate degree or equivalent experience
- Unrestricted, active RN license
- 2+ years of RN experience in acute setting
- Proven working knowledge of Clinical Criteria and CMS Guidelines/InterQual
- Proven proficiency in basic computer skills
- Demonstrated ability to have high speed internet installed in home for Secure Job use only
- Proven designated HIPPA compliant home workspace
Nice To Haves
- Undergraduate degree (BSN)
- Proven utilization management, prior authorization, case management or prior appeals experience
- Proven claims and coding experience
Responsibilities
- Review provider post-service appeals for Medicare and Retirement
- Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines
- Discuss cases with medical directors when applicable
- Ability to communicate and collaborate with other teams in order to gather medical information to process cases
- Communicate effectively in both verbal and written documentation
- Must meet quality and productivity metrics
- Ability to work independently and prioritize
- Attend mandatory trainings and scheduled staff meetings
- Engage in respectful and courteous team dialog via email, IM and in staff meeting
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Insurance Carriers and Related Activities
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
