Clinical Appeals Registered Nurse (RN) - Remote Opportunity in the US

Join UnitedHealthcare, a leader in simplifying the healthcare experience, creating healthier communities, and removing barriers to quality care. As a Clinical Appeals RN, you will play a vital role in our mission to build a more responsive, affordable, and equitable healthcare system. If you're passionate about making a difference in the lives of millions, we invite you to start your journey with us, where you'll experience a culture of caring, connecting, and growing together.

In this remote role, you will work on post-service appeals for Medicare-based claims, utilizing your clinical expertise to review provider appeals, gather medical records, and collaborate with medical directors. Your exceptional communication skills will enable you to effectively discuss cases with internal stakeholders and provide clear, concise documentation. As a key member of our team, you will be responsible for:

• Reviewing provider post-service appeals for Medicare and Retirement claims
• Gathering clinical information, including medical records and coverage criteria, in accordance with Medicare guidelines
• Collaborating with medical directors to discuss complex cases
• Communicating effectively with internal stakeholders to gather medical information and process cases
• Maintaining high-quality documentation and meeting productivity metrics
• Working independently, prioritizing tasks, and attending mandatory trainings and staff meetings

To succeed in this role, you will need:

• An undergraduate degree or equivalent experience
• An unrestricted, active RN license
• At least 2 years of RN experience in an acute setting
• Proven working knowledge of Clinical Criteria and CMS Guidelines
• Basic computer skills and a designated HIPAA-compliant home workspace with high-speed internet

Preferred qualifications include:

• A Bachelor of Science in Nursing (BSN) degree
• Experience in utilization management, prior authorization, case management, or prior appeals
• Claims and coding experience

We offer a competitive hourly rate of $28.61 to $56.06, based on full-time employment, as well as a comprehensive benefits package, incentive and recognition programs, and opportunities for professional growth and development. At UnitedHealth Group, we are committed to creating a diverse and inclusive workplace, where everyone has the opportunity to thrive. We are an Equal Employment Opportunity/Affirmative Action employer and welcome applications from qualified candidates of all backgrounds.

Ready to join our team and make a difference in the lives of millions? Apply now to start your journey with UnitedHealthcare.