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Clinical Appeals RN (M&R) - Remote (M-F 8-5)
At UnitedHealthcare, we\'re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims.
Primary Responsibilities:
- Review provider post-service appeals for Medicare and Retirement
- Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines
- Discuss cases with medical directors when applicable
- Ability to communicate and collaborate with other teams in order to gather medical information to process cases
- Communicate effectively in both verbal and written documentation
- Must meet quality and productivity metrics
- Ability to work independently and prioritize
- Attend mandatory trainings and scheduled staff meetings
- Engage in respectful and courteous team dialog via email, IM and in staff meeting
You\'ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Undergraduate degree or equivalent experience
- Unrestricted, active RN license
- 2+ years of RN experience in acute setting
- Proven working knowledge of Clinical Criteria and CMS Guidelines/InterQual
- Proven proficiency in basic computer skills
- Demonstrated ability to have high speed internet installed in home for Secure Job use only
- Proven designated HIPPA compliant home workspace
Preferred Qualifications:
- Undergraduate degree (BSN)
- Proven utilization management, prior authorization, case management or prior appeals experience
- Proven claims and coding experience
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you\'ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Experience: 3 years required
