Senior Clinical Appeals Reviewer - National Remote - UnitedHealth Group

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work.^SM

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 4:30pm CST. It may be necessary, given the business need, to work occasional overtime or weekends. 

We offer weeks of on-the-job training. The hours of the training will be Monday-Friday 8am - 4:30pm CST.

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

Primary Responsibilities:

• Excellent verbal and written communication skills with Pharmacists, Medical Directors, and Business Partners

• Work efficiently to meet daily deadlines for appeal review Case Preparation, Case Pre-Closure, Outreach, and proper system documentation for every appeal

• Work efficiently to meet deadlines when applicable for External Review Submissions, Peer-to-Peer Scheduling with proper system documentation

• Model proper attendance and schedule adherence habits

• Ability to remain focused to avoid incorrect appeal cases going for clinical review with minimal supervision

• Meet departments production and quality standards while maintaining good working relationships

• Work independently and as a team player to achieve individual and departmental goals

• Ability to learn multiple Windows-based applications and appeals systems

• Make outbound phone calls/faxes to collect clinical information for both E&I Commercial, E&I Medical Injectable, and new business product appeals

• Become knowledgeable with  workflow process for variety of case types, regulations, and state mandates to best support our members

• Ability to keep up to date on the changing policies, job aids, and resources to provide a quality review

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:

• High School Diploma / GED

• 2+ years of Pharmacy Technician experience

• 1+ years working experience with Microsoft Office

• Must be 18 years of age OR older

• Prior stable work experience with excellent attendance, dependability

• Intermediate (or higher) proficiency with Windows-based applications

• Active State board of Pharmacy Technician Licensure in your state of residence or National Certification

• Ability to work 40 hours per week - our normal business hours of 8:00am – 4:30pm CST including weekends, holidays, and overtime based on the needs of the business.

Preferred Qualifications:

• 4+ years of Pharmacy related experience

• Remote work experience

• Previous Medical or clinical roles

• Previous experience as a Pharmacy Technician in retail, hospital, specialty pharmacy

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Great collaboration skills

• Self-motivated and detail oriented

• Ability to remain focused and productive each day though tasks may be repetitive

Physical & Work Environment:

• Frequent speaking, listening while using a phone headset, sitting, use of hands/fingers across keyboard or mouse, long periods looking at a computer monitor.

• Requires attendance and attention to topics covered at regularly scheduled team and overall Department meetings. Participation in meetings is encouraged.

California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Nevada / New York / New Jersey / Washington / Rhode Island residents is $22.45 - $43.89 per hour. 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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.

#RPO #GREEN