Clinical Appeals RN - Commercial LOB - Remote in US

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together You'll enjoy the flexibility to work remotely

• from anywhere within the U.S. as you take on some tough challenges. This role can either work a M-F schedule (must be able to work until 5:30 in their time zone) OR a 4 day 10 hour work week but one of those work days must be a Saturday.

Primary Responsibilities

• Conducts reviews of member and provider appeals
• Analyzes claim adjustment and claim history
• Reviews history of previous reviews
• Reviews denied services in conjunction with policies and procedures, benefit plans, federal and state regulations, and clinical criteria to and renders approval when appropriate
• Extrapolates and summarizes medical information for review by Medical Director, as needed
• Balances the need to produce high quality work with meeting timeframes and production goals

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

• Active, unrestricted RN license in state of residence
• 5+ years of clinical experience as an RN including in an acute, inpatient hospital setting
• Experience applying benefits and criteria to clinical review
• Utilization Management, pre-authorization, concurrent review or appeals experience
• Solid computer skills including proficiency in Microsoft Office Word, Outlook, and Internet applications
• Ability to access multiple computer platforms
• Access to install secure high-speed internet (minimum speed 5 download mps & 1 upload mps) via cable/DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement)
• Designated quiet workspace in your home (separated from non-workspace areas) and able to be secured to maintain Protected Health Information (PHI) and/or Protected Information (PI)
• Ability to work 9am-6pm CST

Preferred Qualifications

• Bachelor of Science in Nursing
• Medical Coding experience/knowledge
• Experience using Interqual
• Experience with the following systems: UNET, iCUE/HSR, ATS, ETS or Cirrus
• Experience analyzing medical records, benefit plans, medical policies and other various criteria
• Demonstrated ability to work independently with solid self-discipline and time management skills
• Demonstrated excellent communication, interpersonal, problem-solving, and analytical skills
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. Apply tot his job Apply To this Job