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Clinical Appeals RN - Remote

  • Job
    Full-time
    Senior Level
  • Research & Development
    Healthcare
  • Wausau
    Remote

AI generated summary

  • You must have an active RN license, 5+ years in acute care, intermediate MS skills, strong self-discipline, a quiet workspace, and access to secure high-speed internet.
  • You will perform medical reviews on provider and member appeals, ensure compliance with guidelines, interpret plan language, apply clinical criteria, and document determinations accurately.

Requirements

  • 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)

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

FAQs

Do we support remote work?

Yes, this position is fully remote and allows you to work from anywhere within the U.S.

What are the primary responsibilities of the Clinical Appeals RN?

The primary responsibilities include performing medical reviews on provider inquiries and member appeals, adhering to guidelines, interpreting plan language, utilizing clinical guidelines, and accurately documenting determinations.

What qualifications are required for this position?

You must have active, unrestricted RN licensure in your state of residence, 5+ years of RN experience in an acute care inpatient facility, intermediate Microsoft skills, and the ability to work independently.

Is a BSN degree necessary for this role?

A BSN degree is preferred but not mandatory; candidates with an RN license and the required experience are also considered.

What is the expected hourly pay range for this position?

The hourly pay range is $28.03 to $54.95, depending on various factors such as local labor markets, education, and work experience.

Do I need experience in the health insurance industry?

While health insurance industry experience is preferred, it is not strictly required for this position.

What technical requirements are needed to work from home?

You must have a designated quiet workspace and access to secure high-speed internet with a minimum speed of 5 Mbps download and 1 Mbps upload.

What types of experience are beneficial for this role?

Beneficial experiences include analyzing medical records, knowledge of ICD-10/CPT coding, utilization management, and familiarity with appeals guidelines.

Are there diversity and inclusion initiatives at UnitedHealth Group?

Yes, UnitedHealth Group is committed to creating a diverse and inclusive workplace and addressing health disparities.

Is a drug test required for employment?

Yes, candidates are required to pass a drug test before beginning employment at UnitedHealth Group.

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

When it comes to your health, everything matters. That’s why UnitedHealthcare is helping people live healthier lives and making the health system work better for everyone. Our health plans are there for you in moments big and small, delivering a simple experience, affordable coverage, and supportive care. Wherever your health takes you, we're there for what matters. At UnitedHealthcare, part of the UnitedHealth Group family of businesses, we are working to create a system that is connected, aligned and more affordable for all involved; one that delivers high quality care, responsive to the needs of each person and the communities in which they live. With connections to more than 1.3 million physicians and care professionals and 6,500 hospitals and care facilities across the globe, we can collaborate in new ways to improve patient care while providing customizable and comprehensive solutions in any marketplace, anywhere.

Culture & Values

  • Integrity

    Honor commitments. Never compromise ethics.

  • Compassion

    Walk in the shoes of the people we serve and those with whom we work.

  • Relationships

    Build trust through collaboration.

  • Innovation

    Invent the future. Learn from the past

  • Performance

    Demonstrate excellence in everything we do.

Benefits

  • United Well-being

    United Well-being supports employees in their journey to better health. Resources include: Exercise and mindfulness apps. Tips and recipes for healthy cooking. Wellness coaching and financial tools. A private employee community group.

  • Health and Insurance

    Our medical plans for employees deliver better value and better outcomes. We offer: Copay plans and HSA-eligible plans. Vision and dental plans. Flexible spending accounts. Life insurance, and more.

  • Savings and Retirement

    In addition to competitive pay, we provide financial benefits to help employees manage their money. Benefits include: 401(k) Savings Plan. Employee Stock Purchase Plan. UnitedHealth Group credit union, and more.

  • Paid Time Off (PTO)

  • Paid Company Holidays

  • Parental Leave

  • Employee Assistance Program