Clinical Appeals Nurse RN Home Infusion Telecommute

Overland Park, Kansas
May 01, 2022
May 17, 2022
Contract Type
Full Time
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

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 - 5:30pm CST.

You’ll enjoy the flexibility to telecommute* from anywhere within United States 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
  • 2+ years of clinical experience as a Registered Nurse
  • 2+ years of  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
  • Experience writing Appeals letters
  • Home Infusion experience
  • Knowledge of specialty infusions such as IVIG and Remicade
  • Advanced computer skills; Experience in a paperless role
  • 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
  • CPR+ software experience
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.


Careers with Optum Infusion Pharmacy. If you choose a career with Optum Infusion Pharmacy, you’ll join a team that is dedicated not only to delivering the latest in home infusion therapy, but also providing that care in a patient-first approach that offers better outcomes. As part of the Optum and UnitedHealth Group family of businesses, we strive to help our patients feel comfortable in their regimen so they can receive the treatment they need while maintaining the lifestyle they prefer. At Optum Infusion Pharmacy, you’ll join a team that inspires you to do better every day, resulting in your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $26.15 to $46.63. The hourly range for Connecticut / Nevada residents is $28.85 to $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.

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