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Clinical Appeals RN - Remote in EST time zone

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  • Job
    Full-time
    Junior, Mid & Senior Level
  • Healthcare
  • Charlotte
    Remote

Requirements

  • Current, valid, and unrestricted RN licensure in your state of residence
  • 2+ years of clinical experience in an acute care or an outpatient setting
  • 1+ year of direct experience within one (or more) of the following areas:
  • Utilization Review
  • Medicaid and/or Medicare appeals experience
  • LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC
  • Proven experience/understanding of billable services and claims in a managed care environment
  • Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills
  • Have access to high-speed internet
  • Ability to work 8-5 within EST (Eastern standard time zone)

Responsibilities

  • Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid
  • Identify if additional information is required to process an appeal
  • Ability to adapt to changes that require cross training on appeal types as they are identified
  • Ability to work independently
  • Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision on administrative nurse level cases
  • Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities

FAQs

Do we support remote work?

Yes, this position allows for remote work from anywhere within a state in the Eastern Standard Time zone.

What are the working hours for this role?

The work schedule is generally Monday through Friday, from 8 AM to 5 PM EST.

What qualifications are required for this position?

Candidates must have a current and valid RN licensure in their state of residence, at least 2 years of clinical experience in an acute care or outpatient setting, and 1+ year of experience in areas such as Utilization Review, Medicaid and/or Medicare appeals, or discharge planning.

Is experience with Medicare and Medicaid a requirement?

Yes, at least 1 year of direct experience with Medicare and/or Medicaid appeals is required.

What computer skills are needed for this job?

Candidates should have solid skills in Microsoft Office applications, including Word, Excel, and Outlook, as well as basic computer skills to navigate multiple systems.

Is there a specific geographical location requirement for this role?

Yes, candidates must reside within a state that is in the Eastern Standard Time zone.

What is the pay range for this position?

The hourly range for this role is between $28.03 to $54.95, depending on factors such as local labor markets, education, and experience.

Are there any preferred qualifications for this role?

Preferred qualifications include solid coding experience or being a Certified Coder (CPC) and having 5+ years of Medical Appeal experience working with Medicare and Medicaid.

Will I be required to adhere to any specific policies while working remotely?

Yes, all employees working remotely are required to adhere to UnitedHealth Group’s Telecommuter Policy.

What is UnitedHealth Group's stance on diversity and inclusion?

UnitedHealth Group is committed to creating a diverse workplace and is an Equal Employment Opportunity/Affirmative Action employer, ensuring that all qualified applicants receive consideration without regard to various protected characteristics.

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

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