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UnitedHealthcare serves employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) 
  
As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims. 

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
  
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 meetings

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
• Working knowledge of Clinical Criteria and CMS Guidelines
• Proficient in Basic Computer Skills
• Ability to have high speed internet installed in home for Secure Job use only
• Designated HIPPA compliant home workspace

Preferred Qualifications:

• Undergraduate degree (BSN)
• Utilization management, prior authorization, case management or prior appeals experience
• Claims and coding experience
• If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
 

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $26.15 to $46.63. The hourly range for Connecticut / Nevada residents is $28.85 to $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: RN, Nurse, Appeals, Grievances, CMS, Coding, CPC, CMS, Guidelines, MCG, UR, Utilization Review, Utilization Management, Case Manager, Case Management, Clinical Review, Clinical Claims Review, Claims Review, Telecommute, Remote, work from home, Cypress, California, CA