Job title: Clinical Appeals RN – National Remote
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.We currently seek an experienced RN with solid interpersonal skills to join our team. The chosen Clinical Appeals RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. In providing consumer-oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs, and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.This is a remote position, Monday – Friday position, standard business hours in the time zone that you reside, occasional overtime on an as needed basis.You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
- Clinical Appeals (analyzing, reviewing appeals)
- Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
- Works with less structured, more complex issues
- Solves moderately complex problems and/or conducts moderately complex analyses
- Translates concepts into practice
- Assesses and interprets customer needs and requirements
- Identifies solutions to non-standard requests and problems
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Provides explanations and information to others on difficult issues
- Coaches, provides feedback, and guides others
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 your state of residence
- 3+ years of clinical experience in a hospital, acute care, or direct care setting
- Proven medical record review and/or appeal review experience
- Proven proficiency in using Microsoft business applications and possess strong PC skills
- Access to high-speed internet from home
- Demonstrated ability to work Monday – Friday- ability to work until 6 CST (will discuss schedule during interview)
Preferred Qualifications:
- Proven utilization Management experience
- Experience working in a managed care environment (insurance company or medical group)
- Proven knowledge of Medicaid regulations
- Proven knowledge ICUE
- Proven knowledge InterQual
- Demonstrated solid critical thinking, analytical and research skills
- Proven ability to adapt to change and work in a high-volume environment
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyCalifornia, Colorado, Connecticut, Hawaii, 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.#RPO
Expected salary: $28.03 – 54.95 per hour
Location: Santa Fe, NM
Job date: Sat, 31 Aug 2024 22:42:55 GMT
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