Remote Clinical Appeals RN | Utilization & Grievances

UnitedHealth Group; United States; Remote; USD 40,000 - 71,000; Full time

Benefits offered by this job

Telecommuter policy

Job summary

UnitedHealth Group's UnitedHealthcare division is seeking a Clinical Appeals RN to work remotely from anywhere in the United States. You will analyze appeals and grievances, act as clinical interface liaison, and apply evidence-based criteria to determine coverage decisions.

The role follows a Monday–Friday schedule with 8:00–4:30 in the local time zone and alternating Saturdays; overtime may be required. You will collaborate with medical directors, facilities, and providers to resolve complex

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

Skills

RN license

RN experience

Microsoft Office

Remote work readiness

Education

Bachelor of Science in Nursing (preferred)

Tools

Microsoft Office

Job description

UnitedHealth Group's UnitedHealthcare division is seeking a Clinical Appeals RN to work remotely from anywhere in the United States. You will analyze appeals and grievances, act as clinical interface liaison, and apply evidence-based criteria to determine coverage decisions.

The role follows a Monday–Friday schedule with 8:00–4:30 in the local time zone and alternating Saturdays; overtime may be required. You will collaborate with medical directors, facilities, and providers to resolve complex