Remote Clinical Appeals RN, CA


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Requisition Number: 2178420
Job Category: Nursing
Primary Location: Cypress, CA
(Remote considered)

At UnitedHealthcare, we’re 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 and start doing your life’s best work.(sm) 


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

Primary Responsibilities:

  • Assesses and interprets customer needs and requirements
  • Identifies solutions to non-standard requests and problems
  • Solves moderately complex problems and/or conducts moderately complex analyses
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Translates concepts into practice
  • Provides explanations and information to others on difficult issues

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: 

  • Current, valid, and unrestricted RN licensure in your state of residence
  • 2+ years of clinical experience in an acute care or an outpatient setting
  • 1+ years of direct clinical appeals experience and/or 1+ years of Utilization Review and/or Medical Appeal experience
  • Review of Medical Necessity and discharge planning experience
  • Experience working in a Managed Care environment
  • Knowledge of InterQual guidelines and CMS guidelines Medicare Knowledge
  • Demonstrated solid Microsoft Office (Word, Excel & Outlook) Basic computer skills
  • Demonstrated ability to articulate confidence in their nursing assessment skills
  • Have access to high-speed internet

Preferred Qualifications:  

  • RN licensure with current unrestricted licensure in applicable state
  • 5+ years of Medical Appeal experience
  • Solid coding experience or Certified Coder
  • Solid Appeals or Utilization Management Skills
  • Demonstrated critical thinking skills and solid organizational skills
  • Demonstrated ability comfortably work independently
  • Proven ability to move from one program to another

Careers with UnitedHealthcare. Work with a Fortune 5 organization that’s serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.   


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

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island 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.