Clinical Appeals RN - 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. We are currently seeking experienced RNs with solid interpersonal skills to join our team. The Clinical Appeals RN will be responsible for reviewing appeals and provider inquiries for clinical eligibility for coverage as prescribed by the plan benefits. As a post-service clinical appeals RN, you will be putting your detective skills to the test as you investigate and review a variety of medical services. If you are looking for a challenging and rewarding career, a clinical appeals RN position could be perfect for you. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Requirements
- Active, unrestricted RN licensure in the state of residence
- 5+ years of RN experience in an acute care Inpatient facility (i.e., ICU, CCU, Oncology, ER, OR, etc.)
- Intermediate Microsoft skills (MS Word and Outlook)
- Proven ability to work independently with solid self-discipline, problem solving and time management skills
- Designated quiet workspace in your home (separated from non-workspace areas)
- Access to install secure high-speed internet (minimum speed 5 download MPs and 1 upload MPs) via cable/DSL in home (wireless/cell phone provider, satellite, microwave, etc. does NOT meet this requirement)
Nice To Haves
- BSN degree or higher
- Experience analyzing medical records, benefit plans, medical policies, and other various criteria
- Health Insurance industry experience
- Utilization Management, pre-authorization, concurrent review, or appeals experience
- Proven knowledge of ICD - 10 / CPT coding
- Proven knowledge or experience with InterQual
- Proven knowledge of DOL and state appeals guidelines
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Responsibilities
- Perform medical reviews on provider inquiries and member appeals
- Works within Department of Labor and State guidelines
- Adherence to all confidentiality regulations and agreements
- Reviews and interprets Plan language appropriately
- Utilizes clinical guidelines and criteria appropriately
- Accurately documenting determinations
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
