Clinical Appeals RN - IG Therapy / Biologics - Remote

Lensa; Lenexa (KS); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Clinical Appeals RN to work remotely. This role involves analyzing treatment protocols, advocating for patients, and collaborating with a multidisciplinary team to enhance patient outcomes. Join a dynamic team dedicated to improving health equity and outcomes for patients requiring complex infusible medications.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Stock purchase options

401(k) contributions

Qualifications

• Licensed Registered Nurse (RN) in the state of residence.
• 3+ years of experience in clinical appeals.
• 2+ years of clinical experience specializing in infusion.

Responsibilities

• Document patient demographic data and care history.
• Develop a consultative relationship with assigned physicians.
• Facilitate resolution of treatment requests for assigned patients.

Skills

Clinical Appeals

Infusion Therapy

Advocacy

Education

Bachelor's Degree

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

SharePoint

CPR+ Software

Job description

Clinical Appeals RN - IG Therapy / Biologics - Remote

1 day ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. If you want to achieve more in your mission of healthcare, you have to be really smart about the business of healthcare.

UnitedHealth Group is seeking talented individuals for our Home Infusion Clinical Appeals Nurse opportunities. You will use your talents and experience to analyze proposed treatment protocols to ensure their appropriateness and responsiveness to patient needs and to provide clinical support for writing appeals for patients requiring complex infusible medications. Our elite team of Clinical Appeals Nurses is growing, and we want YOU to join this dynamic and exciting group.

The Home Infusion Clinical Appeals Nurse plays an integral role in the clinical and intake operations of the organization, working collaboratively with a multidisciplinary team to ensure infusion therapy can be safely and effectively administered to each home-based patient. The work schedule will be Monday - Friday, from 8:30 am to 5:30 pm CST.

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

Primary Responsibilities

• Document patient demographic data and care history, and compose letters or emails to payers with proposed treatment plans in accordance with health plan requirements.
• Develop a consultative relationship with assigned physicians, clinics, and patients to build a patient-focused approach to care.
• Facilitate resolution of treatment requests for assigned patients.
• Advocate for patient viewpoints to payers on decisions directly affecting coverage-related concerns.
• Participate in committees, work groups, and process improvement teams to enhance patient outcomes and satisfaction.

You’ll be rewarded and recognized for your performance in an environment that will challenge you, provide clear success criteria, and support your development for future roles.

Required Qualifications

• Licensed Registered Nurse (RN) in the state of residence.
• 3+ years of experience in clinical appeals, grievances, and post-payment review.
• 2+ years of clinical experience specializing in infusion (e.g., Ig therapy and/or Biologics).
• Solid experience in autoimmune, primary immune, and/or inflammatory disease states.
• Understanding of clinical documentation from physician offices and telephonic patient assessments.
• Proficiency with Microsoft Outlook, Word, Excel, and SharePoint.

Preferred Qualifications

• Bachelor’s degree.
• Experience with CPR+ software.
• Experience working remotely as a Clinical Appeals RN.
• Experience with infusion therapy approvals and denials.
• Knowledge of health insurance summary plan descriptions.
• Understanding of payer reimbursement processes, co-pays, co-insurances, and deductibles.
• Familiarity with government payment systems such as Medicare and Medicaid.
• Advanced computer skills and experience in a paperless environment.

The hourly range for this role is $28.61 to $56.06, based on full-time employment and various factors including location, education, experience, and certifications. UnitedHealth Group complies with all applicable minimum wage laws. Benefits include a comprehensive package, incentive and recognition programs, stock purchase options, and 401(k) contributions, subject to eligibility.

This posting will remain open for at least 2 business days or until a sufficient candidate pool is reached. Early removal is possible due to volume of applicants.

Our mission at UnitedHealth Group is to help people live healthier lives and improve the healthcare system for everyone. We are dedicated to addressing health disparities and promoting health equity, especially for marginalized groups and those with lower incomes.

UnitedHealth Group is an Equal Employment Opportunity employer. Qualified applicants will be considered regardless of race, gender, age, religion, sexual orientation, gender identity, disability, veteran status, or any other protected characteristic. We are also a drug-free workplace requiring candidates to pass a drug test prior to employment.