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Senior Clinical Appeals RN - New Hyde Park, NY

UnitedHealth Group


Location:
NEW HYDE PARK, NY
Date:
09/05/2017
2017-09-052017-10-04
Job Code:
1776840
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Job Details


Senior Clinical Appeals RN - New Hyde Park, NY(Job Number:726801)
Description

If you're looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
 
This is an office based role located in New Hyde Park, NY.
 
Primary Responsibilities:
  • Coordinates appeals process
  • Sorts, reviews and evaluates cases denied by all payers and determines follow through for first, second and third level appeals within contractual or appropriate timeframes
  • Monitors inpatient denials and assists patients and physicians with management of the appeals process
  • Writes first, second and third level insurance appeal letters
  • Reviews and coordinates utilization issues concurrently and retrospectively related to denials from all payors
  • Maintains data tracking systems and identifies Utilization trends
  • Serves as a resource to all hospital staff related to Utilization Management issues
  • Promotes staff development and education
  • Assesses and monitors of quality issues, and follows-up with Quality Management
  • 3 years of recent clinical experience
  • Attends committee and staff meetings, as required
  • Performs related duties as required

Job Clinical Appeals-SCA
Primary Location US-NY-NEW HYDE PARK
Other Location 
Organization O360 Northwell Back Ops
Schedule Full-time
Number of Openings 3
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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