Clinical Appeals RN - Remote Opportunity in EST Time Zone

Join UnitedHealthcare in transforming the healthcare experience, creating healthier communities, and breaking down barriers to quality care. As a Clinical Appeals RN, you will play a vital role in making a positive impact on the lives of millions. Enjoy the flexibility of working remotely from anywhere within the Eastern Standard time zone, with a standard Monday-Friday schedule from 8am-5pm EST.

In this role, you will:

• Conduct initial assessments of appeals, medical records, and CMS/State Policies to determine coverage and billable criteria
• Identify the need for additional information to process appeals
• Utilize clinical nursing judgment and critical thinking skills to make informed decisions on administrative nurse-level cases
• Navigate multiple computer programs, managing multiple tasks and priorities
• Adapt to changes and cross-train on various appeal types as needed

In return for your expertise, you will be rewarded with a competitive salary, comprehensive benefits package, and opportunities for professional growth and development. If you are a motivated and experienced RN looking to make a difference, we encourage you to apply.

Required Qualifications

• Current, valid, and unrestricted RN licensure in your state of residence
• 2+ years of clinical experience in an acute care or outpatient setting
• 1+ year of direct experience in Utilization Review, Medicaid and/or Medicare appeals, or LOC assessment planning and Discharge SNF Planning
• Proven understanding of billable services and claims in a managed care environment
• Solid Microsoft Office skills and basic computer proficiency
• Access to high-speed internet and ability to work 8am-5pm EST

Preferred Qualifications

• Solid coding experience or Certified Coder (CPC) certification
• 5+ years of Medical Appeal experience working with Medicare and Medicaid

UnitedHealth Group offers a competitive hourly range of $28.03 to $54.95 per hour, depending on location, experience, and qualifications. Our comprehensive benefits package includes incentives, recognition programs, equity stock purchase, and 401k contribution. We are an Equal Employment Opportunity/Affirmative Action employer, committed to diversity and inclusion in the workplace.

To apply, please submit your application through our website. We look forward to hearing from you!