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Clinical Appeals RN - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Cypress, CA Cypress, California |
About this job
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?
As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims.
Primary Responsibilities:
Review post service member and provider appeals
Gather clinical information
Perform reviews using applicable criteria
Discuss cases with medical directors when applicable
Requirements
Required Qualifications:
Unrestricted, active RN license
2+ years of RN experience in an acute setting
Ability to create, edit, save and send documents
Ability to navigate a Windows environment, including Microsoft Word and Microsoft Outlook, as well as, to conduct Internet searches
Preferred Qualifications:
Undergraduate degree (BSN) or equivalent experience
Claims and coding experience
Utilization management, prior authorization, and case management experience
Working knowledge of Milliman and CMS
UnitedHealthcare serves 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.
Job Keywords: Appeals Nurse, Appeals RN, Medicare Appeals, Claims Appeals
Unrestricted, active RN license
2+ years of RN experience in an acute setting
Ability to create, edit, save and send documents
Ability to navigate a Windows environment, including Microsoft Word and Microsoft Outlook, as well as, to conduct Internet searches
Preferred Qualifications:
Undergraduate degree (BSN) or equivalent experience
Claims and coding experience
Utilization management, prior authorization, and case management experience
Working knowledge of Milliman and CMS
UnitedHealthcare serves 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.
Job Keywords: Appeals Nurse, Appeals RN, Medicare Appeals, Claims Appeals
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