Clinical Appeals RN – Must work 9-6 CST – Remote in Tacoma, WA ID - 11136
Company: UnitedHealth Group
Job description: 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.
The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification).
If you have the ability to work 9-6 cst, you will have the flexibility to work remotely* as you take on some tough challenges
Primary Responsibilities:
- Conducts investigations and reviews of member and provider appeals
- Analyzes claim adjustment and claim history
- Reviews denied services in conjunction with policies and procedures, benefit plans, federal and state regulations, and clinical criteria and renders decision when appropriate
- Extrapolates and summarizes medical information for review by Medical Director, as needed
- Documents case outcome and updates applicable applications
- Balanced the need to produce high quality work with meeting compliance 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 MCG and/or Interqual
- Experience with the following systems: UNET, iCUE/HSR, 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
- Proven excellent communication, interpersonal, problem-solving and analytical skills
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*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Clinical Appeals RN – Must work 9-6 CST – Remote – UnitedHealth Group – Tacoma, WA – work from home job
Expected salary:
Location: Tacoma, WA
Clinical Appeals RN – Must work 9-6 CST – Remote – UnitedHealth Group – Tacoma, WA – work from home job
