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Clinical Appeals RN - Tennessee

UnitedHealth Group

Knoxville, TN
Job Code:
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Job Details

Clinical Appeals RN - Tennessee(Job Number:729504)

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Are you ready for a new path? Start doing your life's best work.(sm)
The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification).
Primary Responsibilities:         
  • Review medical records and verify if the requested service meets criteria
  • Review post service claims for clinical eligibility for coverage as prescribed by the Plan benefits
  • Review and interpret Plan language
  • Coordinate reviews with the Medical Director
  • Utilize clinical guidelines and criteria     
  • Responsible for accurately documenting determinations
  • Adherence to all confidentiality regulations and agreements  

Job Clinical Appeals-SCA
Primary Location US-TN-Knoxville
Other Location US-TN-Memphis, US-TN-Nashville
Organization Clinical Appeals & Grievances
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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