Clinical Appeals RN - Remote - M-F alternating

Clinical Appeals RN - Remote - M-F working alternating Saturdays

At United Healthcare, 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.

The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification).

You’ll enjoy the flexibility to work remotely from anywhere within the U.S.

• Review medical records and verify if the requested service meets criteria
• Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits
• Review and interpret Plan language
• Coordinate reviews with the Medical Director
• Utilize clinical guidelines and criteria
• Accurately document determinations
• Adhere to all confidentiality regulations and agreements
• Work hours M-F 8a-5p with alternating Saturdays
• Comfortable with mandatory overtime

You will 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.

• Active, unrestricted RN license in state of residence
• 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting
• Proficiency in Microsoft Office, Word, Outlook, and Internet applications
• Available M-F, 8:00-4:30 in your time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday)

• Bachelor of Science in Nursing
• 1+ years of experience using MCG and/or Medicare criteria
• 1+ years of Utilization Management, pre‑authorization, concurrent review or appeals experience
• Appeals experience
• Proven excellent communication, interpersonal, problem‑solving, and analytical skills
• All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.

This posting will remain open for a minimum of 2 business days or until a sufficient candidate pool has been collected. The job posting may close early due to volume of applicants.

United Health Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

United Health Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.

Entry level

Full‑time

Health Care Provider

Nursing Homes and Residential Care Facilities