Remote Clinical Appeals RN — Expert Coverage Reviewer

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

Benefits offered by this job

Benefits package

401k

Equity stock purchase

Job summary

UnitedHealthcare is hiring a Clinical Appeals RN to provide expertise in appeals and grievances, analyze cases, and serve as a Clinical Interface Liaison with facilities, providers, and plans. The role supports benefits interpretation and program definitions while ensuring confidentiality.

Remote work is allowed from anywhere in the U.S., with M-F 8:00–4:30 in the local time zone and alternating Saturdays. Overtime is required periodically; benefits include a comprehensive package and 401k.

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).

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.

Skills

RN license

Clinical experience

Education

Bachelor of Science in Nursing

Tools

Microsoft Office

Job description

UnitedHealthcare is hiring a Clinical Appeals RN to provide expertise in appeals and grievances, analyze cases, and serve as a Clinical Interface Liaison with facilities, providers, and plans. The role supports benefits interpretation and program definitions while ensuring confidentiality.

Remote work is allowed from anywhere in the U.S., with M-F 8:00–4:30 in the local time zone and alternating Saturdays. Overtime is required periodically; benefits include a comprehensive package and 401k.