Remote Clinical Appeals RN — Advocate for Coverage

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

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.