Clinical Appeals RN - Remote

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 and start doing your life's best work.(sm)

As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary 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 meetings

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Undergraduate degree or equivalent experience
• Unrestricted, active RN license
• 2+ years of RN experience in acute setting
• Working knowledge of Clinical Criteria and CMS Guidelines
• Proficient in Basic Computer Skills
• Ability to have high speed internet installed in home for Secure Job use only
• Designated HIPPA compliant home workspace

Preferred Qualifications:

• Undergraduate degree (BSN)
• Utilization management, prior authorization, case management or prior appeals experience
• Claims and coding experience

Careers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

California Residents Only: The hourly range for California residents is $27.07 to $53.08. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.