Clinical Appeals RN - Remote in TN

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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 optimized. Ready to make a difference?
Caring. Connecting. Growing together

We are currently seeking an experienced RN with strong interpersonal skills to join our team. The chosen Clinical Appeals & Coding RN will review appeals and grievances to determine if the appropriate care was given. In providing Medicaid community and state provider post‑service appeals, our goal is to create higher quality care, lower costs and greater access to health care. Join us, and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

• Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances)
• Review of coding edits and reimbursement issues
• Works with less structured, more complex issues
• Solves moderately complex problems and/or conducts moderately complex analyses
• Translates concepts into practice
• Assesses and interprets customer needs and requirements
• Identifies solutions to non‑standard requests and problems
• Works with minimal guidance; seeks guidance only on the most complex tasks
• Coaches, provides feedback and guides others

• Active unrestricted RN license in the state of TN
• 3+ years of clinical experience in a hospital, acute care or direct care setting
• Experience reviewing coding edits (CPT) and reimbursement issues
• Medical record review / appeal review experience
• Experience working in a managed care environment (insurance company or medical group)
• Proficient experience with Microsoft Office Suite (Word, Excel & Outlook)
• Proven ability to adapt to change and work in a high‑volume environment
• Proven outstanding coding skills with hands‑on experience with coding edits & reimbursement issues
• Proven solid critical thinking, analytical and research skills
• Ability to work Monday‑Friday from 8:30am‑5:00pm within your time zone

• CPC (Certified Professional Coder)
• Utilization Review experience
• Clinical Chart Reviews
• Post Service Provider Denial experience
• Knowledge of Medicare / Medicaid regulations
• All employees working remotely must 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. In addition to your salary, we offer 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 us, you’ll find a far‑reaching choice of benefits and incentives.

The hourly pay for this role will range from $28.94 to $51.63 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.

Final date to receive applications:
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At United Health Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

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.

Seniority level: Mid‑Senior level

Employment type: Full‑time

Job function: Health Care Provider

Location: Nashville, TN

Estimated Salary: $ - $