Clinical Appeals Nurse Specialist

1 week ago


Cypress, California, United States UnitedHealth Group Full time

UnitedHealth Group is seeking a skilled Clinical Appeals Nurse Specialist to enhance the Medicare appeals process. The ideal candidate will have strong analytical and communication skills, as well as a valid RN license.

About the Role
  • This role involves reviewing provider post-service claims for accuracy and completeness.
  • You will analyze clinical data from medical records and coverage criteria to 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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