Clinical Appeals RN

UnitedHealth Group • Minnetonka, MN

86d • $28 - $50 • Onsite

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. If you are located within Eastern Standard time zone, you will have the flexibility to work remotely as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST.

Requirements

• Current, valid, and unrestricted RN licensure in your state of residence
• 2+ years of clinical experience in acute care or an outpatient setting
• 1+ years of direct experience within one (or more) of the following areas: Utilization Review, Medicaid and/or Medicare appeals, LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC
• Proven experience/understanding of billable services and claims in a managed care environment
• Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills
• Access to high-speed internet
• Ability to work 8-5 within EST (Eastern standard time zone)

Nice To Haves

• Solid coding experience or Certified Coder (CPC)
• 5+ years of Medical Appeal experience working with Medicare and Medicaid

Responsibilities

• Perform an initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid
• Identify if additional information is required to process an appeal
• Ability to adapt to changes that require cross training on appeal types as they are identified
• Ability to work independently
• Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decisions on administrative nurse level cases
• Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree