Senior Clinical Appeals RN - Remote (TX)

UnitedHealthcare; Houston (TX); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Incentives & recognition

Job summary

UnitedHealthcare is seeking a Senior Clinical Administrative RN in Texas to review member appeals and fair hearings, coordinating with clinical and non-clinical staff to ensure accurate determinations. The role supports compliance with State and Federal requirements while focusing on quality, access to care, and timely decision-making.

Ideal candidates hold an active Texas RN license with 5+ years in clinical nursing and 3+ years in appeals or regulatory processes, plus strong MS Office skills

Qualifications

• Active, unrestricted RN license in Texas.
• 5+ years in clinical nursing including utilization management or medical necessity review.
• 3+ years in appeals, grievances, or regulatory processes in managed care.
• 3+ years collaborating with Medical Directors or clinicians to support clinical decisions.
• Intermediate proficiency with clinical systems and Microsoft Office Suite.

Responsibilities

• Review determinations and prepare for Fair Hearings with clinical and non-clinical staff.
• Participate in State Fair Hearings and coordinate internal reviews of denial letters.
• Review electronic Health Records to validate decisions and identify needed documentation.
• Perform internal Quality Control reviews and suggest process improvements.
• Maintain knowledge of State rules, contracts and Federal regulations; support compliance.

Skills

Clinical nursing

Utilization management

Appeals & grievances

Regulatory knowledge

Cross-functional collaboration

Education

RN license (Texas)

Tools

Microsoft Office

Job description

UnitedHealthcare is seeking a Senior Clinical Administrative RN in Texas to review member appeals and fair hearings, coordinating with clinical and non-clinical staff to ensure accurate determinations. The role supports compliance with State and Federal requirements while focusing on quality, access to care, and timely decision-making.

Ideal candidates hold an active Texas RN license with 5+ years in clinical nursing and 3+ years in appeals or regulatory processes, plus strong MS Office skills