Clinical Appeals & Coding RN - Telecommute Opportunity

We currently seek an experienced RN with strong interpersonal skills to join our team. The chosen Clinical Appeals & Coding RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. In providing consumer-oriented health benefit plans to millions of people; 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.

This is a work from home / telecommute position.  The shift is Monday - Friday from 9:00 am - 5:30 pm in local time zone.  

Primary Responsibilities:

• Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances)


• Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)


• 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 on only the most complex tasks


• Provides explanations and information to others on difficult issues


• Coaches, provides feedback, and guides others

Required Qualifications:

• Active, unrestricted RN licensure in your state of residence


• 3+ years clinical experience in a hospital, acute care, or direct care setting


• Medical record review / appeal review experience


• Proficient level of experience with Microsoft Office Suite (Word, Excel & Outlook)


• Strong critical thinking, analytical and research skills


• Ability to adapt to change and work in a high volume environment

Additional Preferred Assets:

• Previous medical CPT coding experience


• CPC (Certified Professional Coder)


• Experience performing Coding Edits


• Experience working in a managed care environment (insurance company or medical group)


• Previous Utilization Review experience


• Knowledge of Medicare/Medicaid regulations


• Knowledge of Milliman guidelines

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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: 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.

Key Words: RN, registered nurse, coding, cpt, cpc, certified professional coder, utilization review, utilization management, work from home, telecommute, Medicaid, medical record review, appeal, milliman, coding edits