Posted 9 months ago  

Clinical Appeals Registered Nurse at UnitedHealth Group

Job Description

Title: Clinical Appeals Registered Nurse Telecommute

Location: US

job category: Clinical

job description:

Optum is a company thats on the rise. Were expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isnt about another gadget, its about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your lifes best work.(sm)

Theres an energy and excitement here, a shared mission to improve the lives of others as well as our own. If you want to achieve more in your mission of healthcare, you have to be really smart about the business of healthcare.

UnitedHealth Group is seeking talented individuals for our Home Infusion Clinical Appeals Nurse opportunities. You will be able to use your talents and experience to analyze proposed treatment protocols to ensure their appropriateness and responsiveness to patient needs and to provide clinical support for writing appeals for patients requiring complex infusible medications. Our elite team of Clinical Appeals Nurses is growing and we want YOU to join this dynamic and exciting group.

The Home Infusion Clinical Appeals Nurse fills an integral role in the clinical and intake operations of the organization, working collaboratively with a multi-disciplinary team to ensure infusion therapy can be safely and effectively administered to each home-based patient. The work schedule will be Monday Friday from 9am 6pm CST. Mandatory OT January thru March varies per week.

Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Document patient demographic data and synopsis of care history, and compose letters or emails to payers with proposed treatment plan in accordance with health plan requirements
  • Develop a consultant relationship with assigned physicians/clinics/patients to build and sustain a patient-focused approach to care
  • Facilitate resolution of treatment requests for assigned patients
  • Advocate patient viewpoints to payers on decisions directly affecting coverage-related concerns
  • Participate on committees, work groups, and/or process improvement teams that improve patient outcomes and satisfaction

Youll 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:

  • Licensed Registered Nurse (RN) in the state of residence
  • 3+ years of clinical experience as a Registered Nurse
  • Understanding of clinical documentation from physician offices and telephonic assessment notes of patients
  • Proficiency with Microsoft Outlook, Word, Excel and SharePoint

Preferred Qualifications:

  • Bachelors degree
  • 2+ years of experience in autoimmune, primary immune, and / or inflammatory disease states
  • Home Infusion experience
  • Experience writing Appeals letters
  • Knowledge of specialty infusions such as IVIG and Remicade
  • Advanced computer skills; Experience in a paperless role
  • Understanding of health insurance summary plan description language
  • Understanding of how payer reimbursements work, plus co-pays, co-insurances, and deductibles
  • Understanding of government payment systems such as Medicare and Medicaid
  • CPR+ software experience

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. The hourly range for Connecticut/Nevada residents is $28.27 to $50.29. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

Additional Job Detail Information

Requisition Number

Business Segment

Employee Status

Job Level
Individual Contributor


Country: US

Overtime Status


Day Job

Telecommuter Position

Job Stats

Posted 9 months ago - 147 views - 14 Applied