Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions Ability to train staff andcommunicate well Provides clinical support for performing clinical review of appeals and may also review quality of service issues. Process includes analyzing, reviewing, and evaluating appeals in compliance with state and federally mandated turn-around-times and process requirements Reviews the work of others Develops innovative approaches Sought out as expert Serve... more details
At UnitedHealthcare, were 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 startCaring. Connecting. Growing together.
Mission for this position is to drive strategy and growth through core functionalities that support critical client and consumer results and experience.
Youll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. This role will work 4- 10 hour shifts, Wednesday - Saturday.
Primary Responsibilities:
- Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions
- Ability to train staff andcommunicate well
- Provides clinical support for performing clinical review of appeals and may also review quality of service issues.? Process includes analyzing, reviewing, and evaluating appeals in compliance with state and federally mandated turn-around-times and process requirements
- Reviews the work of others
- Develops innovative approaches
- Sought out as expert
- Serves as a leader/ mentor
- Anticipates customer needs and proactively develops solutions to meet them
- Serves as a key resource on complex and/or critical issues
- Solves complex problems and develops innovative solutions
- Performs complex conceptual analyses
- Reviews work performed by others and provides recommendations for improvement
- Forecasts and plans resource requirements
- Authorizes deviations from standards
- May lead functional or segment teams or projects
- Provides explanations and information to others on the most complex issues
- Motivates and inspires other team member
Youll 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:
- RN degree
- 1+ years of appeals experience
- Ability or willing to work occasional Saturdays
- Proven comfortable with the appeals process and understand the demand and expectations of staying in compliance
Preferred Qualification:
*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The hourly range for this role is $33.75 to $66.25 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.
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 everyoneof every race, gender, sexuality, age, location and incomedeserves 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.
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.
