Clinical Appeals RN - Remote

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 are currently seeking experienced RNs with solid interpersonal skills to join our team. The Clinical Appeals RN will be responsible for reviewing appeals and provider inquiries for clinical eligibility for coverage as prescribed by the plan benefits. As a post-service clinical appeals RN, you will be putting your detective skills to the test as you investigate and review a variety of medical services. If you are looking for a challenging and rewarding career, a clinical appeals RN position could be perfect for you. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

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