Clinical Appeals RN - Remote - M-F working alternating Saturdays

UnitedHealthcare; Cypress (CA); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Remote work

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare is hiring a Clinical Appeals RN for remote work Monday–Friday, with alternating Saturdays. The role analyzes appeals and grievances, acts as a clinical liaison, and supports resolution with facilities, providers, and plans.

We offer a flexible schedule, competitive hourly pay and a comprehensive benefits package. Candidates must hold an RN license, have inpatient RN experience, and be proficient with Microsoft Office.

Qualifications

• Active, unrestricted RN license in state of residence.
• 2+ years of RN clinical experience, including in an acute, inpatient hospital setting.
• Proficiency in Microsoft Office (Word, Outlook) and Internet applications.
• Available M-F 8:00–4:30 in their time zone with alternating Saturdays (2 per month).
• Bachelor of Science in Nursing (BSN) preferred.
• 1+ years with MCG and/or Medicare criteria.
• 1+ years in Utilization Management, pre-authorization, concurrent review or appeals.
• Appeals experience.
• Strong communication, interpersonal, problem-solving and analytical skills.

Responsibilities

• Review medical records and verify if the requested service meets criteria.
• Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits.
• Review and interpret Plan language.
• Coordinate reviews with the Medical Director.
• Utilize clinical guidelines and criteria.
• Accurately documenting determinations.
• Adherence to confidentiality regulations and agreements.
• Hours M-F 8a-5p with alternating Saturdays.
• Comfortable working mandatory overtime.

Skills

RN license

RN clinical experience

Communication skills

Problem solving

Analytical skills

Education

BSN

Tools

Microsoft Office

MCG criteria

Medicare criteria

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Clinical Appeals RN - Remote - M-F working alternating Saturdays (2369974)

Clinical Appeals RN - Remote - M-F working alternating Saturdays - 2369974

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.

The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification).

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Please note this team has a schedule as follows - M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday).

Primary Responsibilities:

• Review medical records and verify if the requested service meets criteria
• Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits
• Review and interpret Plan language
• Coordinate reviews with the Medical Director
• Utilize clinical guidelines and criteria
• Accurately documenting determinations
• Adherence to all confidentiality regulations and agreements
• Hours M-F 8a-5p with alternating Saturdays
• Comfortable working mandatory overtime

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 license in state of residence
• 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting
• Proficiency in Microsoft Office, Word, Outlook, and Internet applications
• Available M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday)

Preferred Qualifications:

• Bachelor of Science in Nursing
• 1+ years of experience using MCG and/or Medicare criteria
• 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience
• Appeals experience
• Proven excellent communication, interpersonal, problem-solving, and analytical skills

*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 re 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 $28.94 to $51.63 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.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.