Talent.com
Clinical Appeals RN - Remote - M-F Working Alternating Saturdays
Clinical Appeals RN - Remote - M-F Working Alternating SaturdaysUnitedHealth Group • Cypress, CA, United States
Clinical Appeals RN - Remote - M-F Working Alternating Saturdays

Clinical Appeals RN - Remote - M-F Working Alternating Saturdays

UnitedHealth Group • Cypress, CA, United States
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
  • serp_jobs.filters.remote
job_description.job_card.job_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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

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. as you take on some tough challenges.

Primary Responsibilities :

  • 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 documenting determinations
  • Adherence to all confidentiality regulations and agreements
  • Hours M-F 8a-5p with alternating Saturdays
  • Comfortable working mandatory overtime
  • 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.

    Required Qualifications :

  • 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 their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday)
  • Preferred Qualifications :

  • 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 UnitedHealth 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 re 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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

    Application Deadline : 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 UnitedHealth 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.

    UnitedHealth 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.

    UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

    serp_jobs.job_alerts.create_a_job

    Clinical Rn • Cypress, CA, United States

    Job_description.internal_linking.related_jobs
    Travel Nurse RN - Home Health

    Travel Nurse RN - Home Health

    Host Healthcare • Anaheim, CA, US
    serp_jobs.job_card.full_time
    Host Healthcare is seeking a travel nurse RN Home Health for a travel nursing job in Anaheim, California.Job Description & Requirements. Pay package is based on 8 hour shifts and 40 hours per we...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health

    Travel Nurse RN - Home Health

    Healthcare Support • Newport Beach, CA, US
    serp_jobs.job_card.permanent
    Healthcare Support is seeking a travel nurse RN Home Health for a travel nursing job in Newport Beach, California.Job Description & Requirements. Healthcare Support Job ID #482077.Pay package is...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health

    Travel Nurse RN - Home Health

    HonorVet Technologies • Newport Beach, CA, US
    serp_jobs.job_card.full_time
    HonorVet Technologies is seeking a travel nurse RN Home Health for a travel nursing job in Newport Beach, California.Job Description & Requirements. Registered Nurse – Home Health / Hospice....serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health - $2,853 per week

    Travel Nurse RN - Home Health - $2,853 per week

    TNAA TotalMed RN • Anaheim, CA, United States
    serp_jobs.job_card.permanent
    TNAA TotalMed RN is seeking a travel nurse RN Home Health for a travel nursing job in Anaheim, California.Job Description & Requirements. We're looking for Home Health RNs for an immediate travel op...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $3,099 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $3,099 per week in Los Alamitos, CA

    AlliedTravelCareers • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    AlliedTravelCareers is working with Windsor Healthcare Recruitment Group, Inc.Nuclear Medicine Tech in Los Alamitos, California, 90720!. Day shift Monday-Friday (Shift times may change) Required Qua...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health - $2,899 per week in Anaheim, CA

    Travel Nurse RN - Home Health - $2,899 per week in Anaheim, CA

    TravelNurseSource • Anaheim, CA, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Coast Medical Service to find a qualified Home Health RN in Anaheim, California, 92805!. Coast Medical Service is a nationwide travel nursing & allied healthcar...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health

    Travel Nurse RN - Home Health

    LanceSoft • Newport Beach, CA, US
    serp_jobs.job_card.permanent
    LanceSoft is seeking a travel nurse RN Home Health for a travel nursing job in Newport Beach, California.Job Description & Requirements. Work Schedule : M - F 8 : 30 am - 5 pm.Required Skills &...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    CRNA - Anesthesiology job available in Downey, California

    CRNA - Anesthesiology job available in Downey, California

    Ascend Medical Staffing • Downey, CA, US
    serp_jobs.job_card.full_time
    ASAP - 3 month with option to extend.Monday – Friday, 7 AM – 3 : 30 PM— Only Full Time, 8 Hours per day, 40 hours per week.serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Nuclear Medicine Tech - $2,739 to $2,939 per week in Los Alamitos, CA

    Travel Nuclear Medicine Tech - $2,739 to $2,939 per week in Los Alamitos, CA

    AlliedTravelCareers • Los Alamitos, CA, US
    serp_jobs.job_card.full_time
    AlliedTravelCareers is working with Ventura MedStaff to find a qualified Nuclear Medicine Tech in Los Alamitos, California, 90720!. Are you ready to take your Travel career to the next level? See p...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Critical Care Float RN - $2,066 per week

    Travel Critical Care Float RN - $2,066 per week

    American Traveler • Orange, CA, United States
    serp_jobs.job_card.part_time
    American Traveler is seeking a travel nurse RN ICU - Intensive Care Unit Med Surg for a travel nursing job in Orange, California. Job Description & Requirements.American Traveler is seeking an exper...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health

    Travel Nurse RN - Home Health

    Skyline Med Staff Home Health • Anaheim, CA, US
    serp_jobs.job_card.full_time
    Skyline Med Staff Home Health is seeking a travel nurse RN Home Health for a travel nursing job in Anaheim, California.Job Description & Requirements. Weekly amount stated in the job postings is...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Critical Care Float RN

    Travel Critical Care Float RN

    American Traveler • Orange, CA, US
    serp_jobs.job_card.part_time
    American Traveler is seeking a travel nurse RN ICU - Intensive Care Unit Med Surg for a travel nursing job in Orange, California. Job Description & Requirements.American Traveler is seeking an e...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health - $2,799 per week

    Travel Nurse RN - Home Health - $2,799 per week

    Supplemental Health Care • Anaheim, CA, United States
    serp_jobs.job_card.full_time +1
    Supplemental Health Care is seeking a travel nurse RN Home Health for a travel nursing job in Anaheim, California.Job Description & Requirements. Supplemental Health Care is hiring experienced RNs w...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health - $2,833 per week

    Travel Nurse RN - Home Health - $2,833 per week

    Continuum Medical Staffing • Anaheim, CA, United States
    serp_jobs.job_card.permanent +1
    Continuum Medical Staffing is seeking a travel nurse RN Home Health for a travel nursing job in Anaheim, California.Job Description & Requirements. Continuum Medical Staffing Job ID #27589.Pay packa...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Telehealth BCBA - Up to 5K Sign on Bonus

    Telehealth BCBA - Up to 5K Sign on Bonus

    Accel Therapies • Orange, CA, US
    serp_jobs.job_card.full_time
    Tahoma, Geneva, sans-serif;"> serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health - $2,228 to $2,572 per week in Anahein, CA

    Travel Nurse RN - Home Health - $2,228 to $2,572 per week in Anahein, CA

    TravelNurseSource • Anahein, CA, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with National Staffing Solutions to find a qualified Home Health RN in Anahein, California, 90805!. Details of the RN - Home Health (HH) opening in Anahein, CA : .Anticipa...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Clinical Appeals RN - Remote - M-F Working Alternating Saturdays

    Clinical Appeals RN - Remote - M-F Working Alternating Saturdays

    UnitedHealth Group • Cypress, CA, United States
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    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 ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Home Health - $1,294 per week in Anaheim, CA

    Travel Nurse RN - Home Health - $1,294 per week in Anaheim, CA

    TravelNurseSource • Anaheim, CA, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with OneStaff Medical to find a qualified Home Health RN in Anaheim, California, 92805!.An independently-owned, nationally-recognized and amazingly awesome staffing fir...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted