Registered Nurse, Appeals - Remote

Lensa; Jeffersonville (IN); Remote; USD 58,000 - 105,000; Full time

Job summary

A leading company in healthcare, Lensa is seeking a Registered Nurse for Appeals to join their team. The role involves drafting appeals, communicating with providers, and ensuring all clinical documentation is obtained, supporting patients with acute and chronic diseases. Flexible remote work options are available.

Qualifications

• 2+ years of clinical experience as a Registered Nurse required.
• 1+ years of experience with prior authorization and appeals.
• Understanding of clinical documentation from physician offices.

Responsibilities

• Drafting appeal letters, obtaining support documents.
• Facilitating appeals process for patients, providers, and insurers.
• Communicating effectively with various stakeholders.

Skills

Communication

Clinical Documentation

Utilization Review

Education

Active, Registered Nurse License

Bachelor’s degree

Tools

MS Word

Excel

SharePoint

Job description

2 days ago Be among the first 25 applicants

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for UnitedHealth Group.

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Here at UnitedHealth Group, you're expected and empowered to be your best, to grow and to develop your skills. Join us and help people live healthier lives while doing your life's best work. Be part of an exciting team within Optum where you can utilize your Operations experience to support multiple internal teams as well as providers and patients.

Registered Nurse, Appeals

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

Primary Responsibilities

The Specialty Appeals Registered Nurse role fills an integral role in drafting and submitting appeals for specialty patients with acute and chronic disease states. In this role you will be preparing appeal letters for submission, obtaining support documents, following up on prior authorization outcomes, and addressing issues and handling concerns from other corresponding departments.

• Communicate with providers, patients, and pharmacy staff to obtain necessary clinical documentation, prior authorizations, and appeal letters
• Facilitate appeals process between the patient, physician, and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician. Composes clinical appeals letters based off of specific denial reason and patients clinical presentation. Ensures all clinical information and documentation are obtained prior to appeal submission
• Accessing multiple Optum resources to check PA, insurance and appeal status and benefits. Utilization of and proficiency in multiple internal processing systems for record keeping and tracking of letter determinations
• Interpret and utilize clinical documentation from providers, and different pharmacy/computer systems
• Utilizing multiple platforms, researching clinical studies for points of argument for appeals
• Write and return assigned appeals to providers
• Utilization of and proficiency in multiple internal processing systems for record keeping and tracking of determinations
• Assign appeal requests to coworkers as needed (rotating schedule)
• Perform other related duties as assigned
  
  

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, Registered Nurse License
• 2+ years of clinical experience as a Registered Nurse
• 1+ years of experience working with prior authorization, pre-certification, utilization review, and / or appeals experience
• Understanding of clinical documentation from physician offices
• Proficiency with MS Word, Excel, SharePoint
• Ability to work independently (At home or office)
• Willingness to obtain Case Management Certification (CCM) once eligible
• Must be able to work an 8 hour schedule between 7am - 7pm CST
  
  

Preferred Qualifications

• Bachelor’s degree
• RN licenses in multiple states (outside of compact states)
• Case Management Certification (CCM)
• PBM and / or Managed Care experience
• Prior Authorization/Appeal Experience
• Knowledge of healthcare insurance plans, denials, and appeal procedures
• Advanced computer skills; Experience in a paperless role
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

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.

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 salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

If you have questions about this posting, please contact [e-mail]

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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