Clinical Appeals Nurse RN Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. If you want to achieve more in your mission of healthcare, you have to be really smart about the business of healthcare.

UnitedHealth Group is seeking talented individuals for our Home Infusion Clinical Appeals Nurse opportunities. You will be able to use your talents and experience to analyze proposed treatment protocols to ensure their appropriateness and responsiveness to patient needs and to provide clinical support for writing appeals for patients requiring complex infusible medications. Our elite team of Clinical Appeals Nurses is growing and we want YOU to join this dynamic and exciting group.

The Home Infusion Clinical Appeals Nurse fills an integral role in the clinical and intake operations of the organization, working collaboratively with a multi-disciplinary team to ensure infusion therapy can be safely and effectively administered to each home-based patient. The work schedule will be Monday - Friday from 9am - 6pm CST.

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

Primary Responsibilities:

Document patient demographic data and synopsis of care history, and compose letters or emails to payers with proposed treatment plan in accordance with health plan requirements
Develop a consultant relationship with assigned physicians / clinics / patients to build and sustain a patient-focused approach to care
Facilitate resolution of treatment requests for assigned patients
Advocate patient viewpoints to payers on decisions directly affecting coverage-related concerns
Participate on committees, work groups, and/or process improvement teams that improve patient outcomes and satisfaction

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:

Licensed Registered Nurse (RN) in the state of residence
2+ years of clinical experience as a Registered Nurse
2+ years of experience in autoimmune, primary immune, and / or inflammatory disease states
Experience writing Appeals letters
Understanding of clinical documentation from physician offices and telephonic assessment notes of patients
Proficiency with Microsoft Outlook, Word, Excel and SharePoint

Preferred Qualifications:

Bachelor's degree
Home Infusion experience
CPR+ software experience
Knowledge of specialty infusions such as IVIG and Remicade
Understanding of health insurance summary plan description language
Understanding of how payer reimbursements work, plus co-pays, co-insurances, and deductibles
Understanding of government payment systems such as Medicare and Medicaid
Advanced computer skills; Experience in a paperless role

Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $27.07 to $53.08. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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, you'll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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.

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.