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.

 

If you're interested in bringing your nursing experience to a role that offers regular, Monday through Friday business hours and ample potential for advancement, apply to join us as one of our newest Clinical Admin Nurses!

 

This position will handle the clinical review of Commercial HMO appeals and will be responsible for completing both standard and expedited member appeal requests. Standard appeals must be completed within 25-30 days. Expedited appeals must be completed within 24-72 hours. Requires telephone contact with Members and/or providers initiating an appeal to explain the process, criteria, and outcome. Requires contact with Medical Groups and/or provider offices for records and case effectuation. Requires occasionally telephone contact with Members. Requires completion of written correspondence for Member outcome letters.

 

This is a high-volume, production environment. You’ll need to be efficient, productive and thorough dealing with our members both verbally and in writing. Solid computer and software navigation skills are critical. You should also be patient-focused and adaptable to changes. In addition, you will be accountable for maintaining compliance with policies and procedures.

 

Must be able to work 8:00am - 5:00pm Pacific Standard Time. Overtime may be required in order to meet compliance with federal/state turn-around times.

 

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

 

Primary Responsibilities: 

Addressing Standard and Expedited appeals cases Completing a standard number of case volume/day Completing the Standard appeals cases within 25-30 calendar days Completing the Expedited appeals cases within 24-72 hours Researching issues to mitigate risk Working closely with a variety of internal departments (i.e. Regulatory, Claims) Communicating directly with Members, medical groups, and physicians Current, unrestricted RN license for the State of CALIFORNIA Knowledge of and/or experience with HMO and Managed Care Solid computer proficiency Exceptional typing skills (at least 65 WPM) Solid organizational skills, must be detail oriented Solid communication skills - written and verbal Must be able to work with established deadlines and quick turnaround times Make referrals to internal and outside sources
 

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: 

Current, unrestricted RN license in the state of residency Current CA RN License or ability to obtain RN license in State of California 3+ years of clinical experience in a hospital or other acute care setting History of navigating a Windows based environment, encompassing exceptional typing skills Articulatable ability to evaluate and interpret medical records, all specialties Ability to work 8:00am - 5:00pm PST (can live in any state as long as you can work Pacific Time zone hours) 
 

Preferred Qualifications: 

BSN degree or higher Experience in appeals CPT, HCPC, ICD-9 and ICD-10 coding experience Experience in appeals, utilization review and/or case management Experience in a production environment either in telephonic or office-based role Declarable creative problem-solving skills Demonstrated team player History of optimizing resources using excellent clinical judgment Proven expertise in providing outstanding customer service while deescalating stressful situations and conversations Proven ability to work independently with minimal supervision Demonstrated attitude that fosters teamwork and supports organizational goals Demonstrated solid written communication 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 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 $28.27 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.