Clinical Appeals RN - Remote

At United Healthcare, 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
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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.

• 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 documents determinations

You will 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.

• 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 Mbps and 1 upload Mbps) via cable/DSL in home (wireless/cell phone provider, satellite, microwave, etc. does NOT meet this requirement)

• BSN degree or higher
• Health Insurance industry experience
• Knowledge of ICD‑10 / CPT coding
• Knowledge or experience with Inter Qual
• 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 United Health 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 401(k) 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.

This posting will be available 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.

United Health 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.

United Health Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.