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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

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 8:30am - 5:30 pm 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

• 3+ years of experience in clinical appeals and grievances, and post-payment review

• 2+ years of clinical experience specializing in infusion (ie Ig therapy and/or Biologics)

• Solid experience in autoimmune, primary immune, and / or inflammatory disease states

• 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

• 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

• Previous experience works remote as a Clinical Appeals RN

• Previous experience working with infusion therapy approvals and/or denials

*All employees working remotely will be required to adhere to UnitedHealth Group’s 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 $28.03 to $54.95 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, you’ll 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 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.