Clinical Appeals RN - Remote in EST or CST Time Zone

Lensa - Charlotte, NC

Job Title: Clinical Appeals RN - Remote in EST or CST Time Zone

Position: Nurse Reviewer

Job Type: Full Time

Pay: $28.61 to $56.06 per hour

Shift: Monday-Friday, 8 AM-5 PM EST or 8 AM-5 PM CST

Work Type: Remote

Address:

City: Charlotte

State: NC

ZIP Code:

Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid.
Identify if additional information is required to process an appeal.
Adapt to changes that require cross training on appeal types as they are identified.
Work independently utilizing clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decisions on administrative nurse level cases.
Navigate multiple computer programs, moving from one system to another while managing multiple tasks and priorities.

Current, valid, and unrestricted RN licensure
2+ years of clinical experience in an acute care or outpatient setting
1+ years of direct experience in Utilization Review, Medicaid and/or Medicare appeals, LOC assessment planning, and Discharge SNF Planning
Solid Microsoft Office (Word, Excel & Outlook) skills
Basic computer skills
Ability to work 8-5 within EST

Experience: 2+ years of clinical experience, 1+ years in specific areas of Utilization Review and appeals

Education:

License & Certification:

Schedule:

COVID-19 Requirements: Not Specified

UnitedHealth Group is committed to mitigating our impact on the environment and delivering equitable care.
Equal Employment Opportunity employer, 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.