Remote Appeals RN - Clinical Decision Expert

UnitedHealth Group; Cypress (CA); Remote; USD 40,000 - 71,000; Full time

Job summary

UnitedHealth Group is seeking a Clinical Appeals RN to provide expert analysis of appeals and grievances, acting as a clinical interface liaison with facilities, providers, and carriers. The role supports equitable, efficient decisions and requires strong documentation and confidentiality adherence.

The position offers remote work from anywhere in the U.S., with an M-F schedule of 8:00–4:30 and alternating Saturdays. A valid RN license and 2+ years of clinical experience are required.

Qualifications

• Active, unrestricted RN license in state of residence.
• 2+ years of clinical RN experience, including acute inpatient settings.
• 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)

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.
• Hours M-F 8a-5p with alternating Saturdays.
• Comfortable working mandatory overtime.

Skills

Clinical nursing expertise

MS Office proficiency

Tools

Microsoft Office

Job description

UnitedHealth Group is seeking a Clinical Appeals RN to provide expert analysis of appeals and grievances, acting as a clinical interface liaison with facilities, providers, and carriers. The role supports equitable, efficient decisions and requires strong documentation and confidentiality adherence.

The position offers remote work from anywhere in the U.S., with an M-F schedule of 8:00–4:30 and alternating Saturdays. A valid RN license and 2+ years of clinical experience are required.