Clinical Appeals RN - Remote anywhere in US!

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

We currently seek an experienced RN with strong interpersonal skills to join our team. The chosen Clinical Appeals RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. In providing consumer-oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. working Monday-Friday from 9:30am-6:00pm EST while working in any time zone as you take on some tough challenges.

Primary Responsibilities:
  • Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances)
  • Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
  • Works with less structured, more complex issues
  • Solves moderately complex problems and/or conducts moderately complex analyses
  • Translates concepts into practice
  • Assesses and interprets customer needs and requirements
  • Identifies solutions to non-standard requests and problems
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Provides explanations and information to others on difficult issues
  • Coaches, provides feedback, and guides others


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:
  • Active, unrestricted RN licensure in your state of residence
  • 3+ years of clinical experience in a hospital, acute care, or direct care setting
  • Utilization Management experience
  • Medical record review/appeal review experience
  • Proficient level of experience with Microsoft Office Suite (Word, Excel & Outlook)
  • Solid critical thinking, analytical and research skills
  • Ability to adapt to change and work in a high-volume environment
  • Access to high-speed internet from home
  • Ability to work Monday-Friday from 9:30am-6:00pm EST (can live in any state/timezone as long as these hours can be met)


Preferred Qualifications:
  • Knowledge of Medicaid regulations
  • Knowledge of Milliman guidelines
  • Knowledge ICUE
  • Knowledge InterQual
  • Experience working in a managed care environment (insurance company or medical group)


To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. The hourly range for Connecticut/Nevada residents is $28.27 to $50.29. 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

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.

Job Keywords: Clinical Appeals RN, UM, Utilization management, Medicaid regs , Charlotte, NC, North Carolina, Dallas, TX, Texas, Phoenix, AZ, Arizona, Hartford, CT, Connecticut, Tampa, FL, Florida, Minneapolis, MN, Minnesota, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

Advertisement

2035391