Clinical Appeals RN - M - F 9 - 6 CST Remote Within CST, MST, PST Or AZ - Remote Eligible

Clinical Appeals RN

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.

Welcome to a challenging yet fulfilling way to help improve the lives of our members. The Clinical Appeals RN reviews member appeals denied at the utilization review level. You will communicate with members, utilize clinical guidelines, and work with medical directors to obtain positive outcomes for our members. We offer the latest tools and an intensive training program to prepare you for completing member appeals.

If you are located in CST, MST, PST or AZ, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances)
• Clinical Interface/Liaison (clinical problem solver with facilities, providers, resolution of issues concerning members, program definition and clarification)
• Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits)
• Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
• Generally work is self-directed and not prescribed
• 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
• Acts as a resource for others with less experience
• The successful candidate in this role must bring solid analytical, organizational and communication skills

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:

• Current, valid and unrestricted RN licensure in your state of residence
• 5+ years of clinical experience in an acute care or an outpatient setting
• 1+ years of Utilization Review or Medical Appeal Review experience
• Solid Microsoft Office proficiency (Word, Adobe, Excel & Outlook) with experience filtering, building pivot tables, etc.
• Access to high-speed internet
• Located in one of these time zones and able to work Monday - Friday and business hours of 9am - 6pm if in CST, 8am - 5pm if in MST or 7am - 4pm if in PST

Preferred Qualifications:

• Undergraduate degree
• 3+ years of Utilization Review experience
• 1+ years of experience in Background in Appeals and Grievances
• Experience working in a Managed Care environment
• Experience working in HSR/ICUE
• Experience working in Doc360
• ICD10 and CPT coding experience
• Experience in a telephonic role

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.