Clinical Appeals RN - Telecommute careerbuilder.com- 1 month ago
This is a full time telecommute position that is Mon- Fri, 8am - 5pm for your particular Time Zone
As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims.
Review provider post-service appeals for Medicare and Retirement
Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines
Discuss cases with medical directors when applicable
Ability to communicate and collaborate with other teams in order to gather medical information to process cases
Communicate effectively in both verbal and written documentation
Must meet quality and productivity metrics
Ability to work independently and prioritize
Attend mandatory trainings and scheduled staff meetings
Engage in respectful and courteous team dialog via email, IM and in staff meetings
Active, Unrestricted RN license
Minimum of at least 2 years of RN experience in acute setting
Working knowledge of MCG and CMS guidelines
Proficient in Basic Computer Skills
Ability to have high speed internet installed in home for Secure Job use only
Designated HIPPA compliant home workspace.
Undergraduate degree (BSN) or equivalent experience
Utilization management, prior authorization, case management or prior appeals experience
Claims and coding experience
Working knowledge of Milliman and CMS
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: RN, Nurse, Appeals, Grievances, CMS, Coding, CPC, CMS, Guidelines, MCG, UR, Utilization Review, Utilization Management, Case Manager, Case Management, Clinical Review, Clinical Claims Review, Claims Review, Telecommute, Remote, work from home, Chicago, New York, California, Phoenix, AZ, Arizona, Illinois, IL, NY, Atlanta, Georgia, GA, Nashville, TN, Tennessee