RN Clinical Appeal Consultant

7 days ago


Cypress, California, United States UnitedHealth Group Full time

UnitedHealth Group seeks a highly skilled RN Clinical Appeal Consultant to support our Medicare appeals process. As a consultant, you will review provider post-service claims, gather clinical information from medical records, and assess coverage criteria against established Medicare guidelines.

About the Position
  • This role requires strong analytical and communication skills to ensure accurate and efficient resolution of appeals.
  • You will collaborate with Medical Directors to discuss complex cases and ensure informed decision-making.

We estimate the salary for this position to be around $65,000 - $90,000 per year.

Responsibilities
  1. Review Medicare appeals for accuracy and completeness.
  2. Analyze clinical data from medical records and coverage criteria.
  3. Communicate with Medical Directors regarding case discussion and decision-making.

Requirements: Valid RN license, strong analytical and communication skills.



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