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.

We are currently seeking experienced RNs with solid interpersonal skills to join our team. The Clinical Appeals RN will be responsible for reviewing appeals and provider inquiries for clinical eligibility for coverage as prescribed by the plan benefits. As a post-service clinical appeals RN, you will be putting your detective skills to the test as you investigate and review a variety of medical services. If you are looking for a challenging and rewarding career, a clinical appeals RN position could be perfect for you.

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

Primary Responsibilities:

• Perform medical reviews on provider inquiries and member appeals
• Works within Department of Labor and State guidelines
• Adherence to all confidentiality regulations and agreements
• Reviews and interprets Plan language appropriately
• Utilizes clinical guidelines and criteria appropriately
• Accurately documenting determinations 

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 licensure in the state of residence
• 5+ years of RN experience in an acute care Inpatient facility (i.e., ICU, CCU, Oncology, ER, OR, etc.)
• Intermediate Microsoft skills (MS Word and Outlook)
• Ability to work independently with solid self-discipline, problem solving and time management skills
• Designated quiet workspace in your home (separated from non-workspace areas) 
• Access to install secure high-speed internet (minimum speed 5 download MPs and 1 upload MPs) via cable/DSL in home (wireless/cell phone provider, satellite, microwave, etc. does NOT meet this requirement)

Preferred Qualifications:

• BSN degree or higher
• Health Insurance industry experience
• Knowledge of ICD - 10 / CPT coding
• Knowledge or experience with InterQual
• Knowledge of DOL and state appeals guidelines
• Experience analyzing medical records, benefit plans, medical policies, and other various criteria
• Utilization Management, pre-authorization, concurrent review, or appeals experience

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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. 

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.

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