UnitedHealthcare
Clinical Appeals RN - Commercial Plan (Weekend Shift) - Remote
Company 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together
Job Description
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. This role will require the ability to work a on Saturday either in a traditional 5 day work week schedule or working 4-10 hour shift but MUST be able to work until 5pm in residing time zone.
Requirements
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 a on Saturday either in a traditional 5 day work week schedule or working 4-10 hour shifts Ability to work until 5pm in residing time zone Preferred Qualifications: Medical Coding experience/knowledge Experience using Interqual Experience with the following systems: UNET, iCUE/HSR, ATS, 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 Demonstrated excellent communication, interpersonal, problem-solving, and analytical skills
Need help crafting an effective cover letter and resume for this role?
Get access to our expert resources: our proven framework offers successful strategies, helps you find the best-fit positions, craft standout cover letters, optimize your resume, and much more.
Get Started
Responsibilities
Conducts reviews of member and provider appeals Analyzes claim adjustment and claim history Reviews history of previous reviews Reviews denied services in conjunction with policies and procedures, benefit plans, federal and state regulations, and clinical criteria to and renders approval when appropriate Extrapolates and summarizes medical information for review by Medical Director, as needed Balances the need to produce high quality work with meeting 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.
.svg)
.svg)
.svg)
.svg)