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Clinical Appeals Registered Nurse - Telecommute

Company: Nurse.com
Location: Cypress
Posted on: November 17, 2022

Job Description:

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing -your life's best work.(sm)

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:


  • Assesses and interprets customer needs and requirements
  • Identifies solutions to non-standard requests and problems
  • Solves moderately complex problems and/or conducts moderately complex analyses
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Translates concepts into practice
  • Provides explanations and information to others on difficult issues -


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    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:


    • Current, valid and unrestricted RN licensure in your state of residence
    • 2+ years clinical experience in an acute care or an outpatient setting
    • 1+ year of direct clinical appeals experience and/or 1+ years of Utilization Review and/or Medical Appeal experience
    • Solid -Microsoft Office (Word, Excel & Outlook)
    • Have access to high speed internet
    • Experience working in a Managed Care environment


      Preferred Qualifications:


      • RN licensure with current unrestricted licensure in applicable state
      • Solid coding experience or Certified Coder
      • 5+ years of Medical Appeal experience
      • Solid Appeals or Utilization Management Skills
      • Review of Medical Necessity and discharge planning experience
      • Basic computer skills
      • Ability to move from one program to another
      • Receive and send email experience
      • Medicare Knowledge
      • Knowledge of InterQual guidelines and CMS guidelines
      • Comfortable -working independently
      • Confident in their nursing assessment skills
      • Critical thinking skills and solid -organizational skills
      • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation


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        To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

        Careers with UnitedHealthcare. -Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do -your life's best work.(sm)

        Colorado, Connecticut or Nevada Residents Only: -The hourly range for Colorado residents is $26.15 to $46.63. The hourly range for Connecticut / Nevada residents is $28.85 to $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

        *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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        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. - - -

Keywords: Nurse.com, Cypress , Clinical Appeals Registered Nurse - Telecommute, Other , Cypress, California

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