Contractor-Registered Nurse jobs at Tenet Healthcare

RN Tele Travel and Local Contracts This role provides direct clinical patient care with Tenet's in-house contingent Pool, Trusted Resource Associates. Work directly with Tenet on a Travel Contract, Local Contract or PRN. With this in-house assignment you will be part of the contingent workforce pool, yet, a W-2 Tenet employee and wear a Tenet employee badge so you blend in as staff and are not outstanding as a Contractor. You will have direct access to Tenet's hiring managers and, if you ever turn permanent at a Tenet hospital, you will have built up tenure. *For a faster reply, email your resume: ******************************* Job Description and Requirements Specialty: Tele Discipline: RN Start Date: ASAP Duration: 13 Weeks 36 Hours per week Shift: 12 Hours Night Employment Type: Travel Contract and Local Contracts TRA RN Tele: The Registered Nurse will assume responsibility for assessing, planning, implementing direct clinical care to assigned patients on a per shift basis, and unit level. The role is responsible for supervision of staff to which appropriate care is delegated. The role is accountable to support facility CNO to ensure high quality, safe and appropriate nursing care, competency of clinical staff, and appropriate resource management related to patient care. Requirements: - BLS, ACLS, and CPI required for Tele - Must have 2 years of nursing experience with a minimum one-year current experience in your specialty Benefits Weekly pay Housing and Per Diem stipend for Travel Contracts Guaranteed Hours (For Travel Contracts) Preferred Booking Agreement (for Local Contacts) Referral bonus (TRA Active Employees) Education: Required: Graduate of an accredited school of nursing. Preferred: Bachelor's or master's degree. Experience: Required: 2 years of current experience in their specialty. Certifications: Required: Currently licensed, certified, or registered to practice profession as required by law, regulation in state of practice or policy; AHA BLS, and if applicable by corporate policy for unit of hire, AHA ACLS and/or PALS and/or NRP. Physical Demands:

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Experience demonstrating knowledge of ICD-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care coding or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Experience demonstrating knowledge of ICD-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care coding or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Experience demonstrating knowledge of ICD-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care coding or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Experience demonstrating knowledge of ICD-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care coding or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Experience demonstrating knowledge of ICD-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care coding or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Experience demonstrating knowledge of ICD-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care coding or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Experience demonstrating knowledge of ICD-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care coding or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Why MountainView Regional Medical Center? We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Team members across our organization enjoy working in team environments and making a difference in the health and well-being of the patients they serve. Their efforts are rewarded through numerous recognition programs and our affiliates also offer team member benefits, including: Competitive compensation Paid time off plans for vacations, holidays and illness Health insurance, including coverage for medical, dental, vision and prescription drugs 401(k) retirement plan Education & student loan assistance Life and disability insurance Flexible spending accounts About Who We Are We are a 168-bed Joint Commission accredited acute care facility serving Las Cruces and southern New Mexico. A legacy of rich history, culture and natural beauty; Las Cruces remains one of the Southwest's best kept secrets. With a thriving arts scene, a focus on downtown, adjacent national monuments and plenty of Southwest charm, there's always something for you and your family to do or see in Las Cruces. Often recognized nationally as a top place to live and retire, Las Cruces offers a welcoming community. MountainView Regional Medical Center is Las Cruces Strong! Start your new job search here and see why we are ….Proud to be MountainView! Job Summary The Care Manager - RN is responsible for coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves collaborating with interdisciplinary teams, reviewing medical records for appropriateness and medical necessity, and maintaining compliance with federal, state, and accreditation standards. Essential Functions Conducts daily reviews of medical records to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. Collaborates with interdisciplinary teams (IDT) to ensure effective communication and coordination of patient care, including identifying avoidable days and resolving care transition issues. Develops and implements discharge plans, coordinating post-hospital placement and social services to meet patient needs. Refers cases to physicians or managers when patients do not meet established criteria, ensuring timely and appropriate interventions. Serves as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients. Facilitates interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning. Maintains accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements. Identifies and appropriately refers cases to Child/Adult Protective Services, ensuring compliance with legal and ethical standards. Provides professional assistance to patients, families, and physicians regarding discharge planning and post-hospital care options. Performs other duties as assigned. Complies with all policies and standards. Qualifications Bachelor's Degree in Nursing preferred 2-4 years of clinical nursing experience in a hospital, home health, or nursing home setting required 2-4 years of care management experience preferred Knowledge, Skills and Abilities Strong understanding of case management principles, discharge planning, and transitions of care. Knowledge of federal, state, and Joint Commission standards related to case management. Excellent communication and interpersonal skills to collaborate effectively with patients, families, and interdisciplinary teams. Ability to assess complex situations, identify solutions, and implement care plans efficiently. Proficiency in electronic medical records (EMR) and documentation systems. Strong organizational and time management skills to prioritize tasks in a dynamic environment. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required BCLS - Basic Life Support required State Specific Requirements Alabama: Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred. New Mexico: Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications preferred.

Seasonal Registered Nurse RN PRN Nights (Job Number: 540389) Description At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient's clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department. Directs, supervises, provides and evaluates nursing care provided to patients. Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated. Assigns nursing care team members in accordance with patient needs, team member's capabilities and qualifications. Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient's medical record according to nursing standards and policies. Performs assessment on all patients on admission and reassessments as per policy. Makes referrals to other disciplines based on assessment. Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team. Assesses and reassesses pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management. Revises the plan of care as indicated by the patient's response to treatment and evaluates overall plan daily for effectiveness. Performs patient care responsibilities considering needs specific to the standard of care for patient's age. Receives physician's orders, ensures transcription is accurate and documents completion. Administers medication utilizing the five rights of medication administration reducing the potential for medication errors. Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice. Performs treatments and provides services to level of licensure. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers. Interacts professionally with patient/family and involves patient/family in the formation of the plan of care. Interprets data about the patient's status to identify each patient's age specific needs and provide care needed by the patient group. Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors. Initiates or assists with emergency measures for sudden adverse developments in patients' condition. Answers telephone, paging system, patients' call lights, anticipates patients' needs, and makes rounds of assigned patients and responds as appropriate. Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs. Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off. Communicates appropriately and clearly to management, co-workers, and physicians. Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs. Participates in orientation, instruction/training of new personnel. Manages and operates equipment safely and correctly. Knowledge/Skills/Abilities/Expectations Knowledge of medications and their correct administration based on age of the patient and their clinical condition. Basic computer knowledge. Able to organize tasks, develop action plans, set priorities and function under stressful situations. Ability to maintain a good working relationship both within the department and with other departments. Approximate percent of time required to travel: 0% Must read, write and speak fluent English. Must have good and regular attendance. Performs other related duties as assigned. Qualifications Education Graduation from an accredited Bachelor of Science in Nursing, Associate Degree in Nursing or Nursing Diploma program. Licenses/Certification Current state licensure as Registered Nurse. BCLS certification required. ACLS certifications preferred. Experience Minimum six months' Medical/Surgical experience in an acute care setting preferred. Job: RNPrimary Location: OH-Lima-Kindred Hospital-LimaOrganization: 4851 - Kindred Hospital-LimaShift: Night

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Applicants for this role have the flexibility to work remotely from their home anywhere in the United States. This position does require an Oregon RN or LPN license. The work schedule for the position is Monday - Friday, 8am - 5pm Pacific, with occasional weekends and holidays.** Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care Assists with service authorization requests for a member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collects, documents, and maintains all member's clinical information in health management systems to ensure compliance with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members Provides feedback on opportunities to improve the authorization review process for members Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience. Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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 to start Caring. Connecting. Growing together. The Senior Clinical Admin Nurse will be responsible for providing individualized attention to UMR membership and covered families and serves to assist with navigation of the health care system. The purpose of the clinical liaison nurse is to help individuals live their lives to the fullest by supporting coordination and collaboration with multiple and external partners including consumers and their families/caregivers, medical, and other clinical teams. Candidate must be willing to work Monday - Friday 8:00 am - 5:00 pm. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently * Educate and guide members regarding BHSUD * Assist members with adverse determinations, including the appeal process * Teach members how to navigate UMR internet-based wellness tools and resources * Outreach to membership providing pre-admission counseling to membership * Outreach to membership providing discharge planning to membership and caretakers * Track all activities and provide complete documentation to generate customer reporting * Accept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary medical care and community referrals as needed * Comply with all policies, procedures and documentation standards in appropriate systems, tracking mechanisms and databases * Contribute to treatment plan discussions * Other duties as assigned 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: * Current and unrestricted RN compact license * 2+ years of acute nursing experience * 2+ years of behavioral health nursing experience * 2+ years of case management experience * Demonstrated basic computer proficiency (i.e. MS Word, Outlook) * Proven ability to function independently and responsibly with minimal supervision Preferred Qualifications: * Bachelor's degree in nursing * CCM * 2+ years of managed care experience * Critical care, pediatric, med-surg and/or telemetry experience * Utilization management experience * Adverse determination experience * Telecommute experience Soft Skills: * Demonstrated excellent verbal and written communication skills * Excellent customer service orientation * Proven team player and team building skills * Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment #UHCPJ * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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 optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** **You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. This role can either work a M-F schedule (must be able to work until 5:30 in their time zone) OR a 4 day 10 hour work week but one of those work days must be a Saturday.** **Primary Responsibilities:** + Conducts reviews of member and provider appeals + Analyzes claim adjustment and claim history + Reviews history of previous reviews + Reviews denied services in conjunction with policies and procedures, benefit plans, federal and state regulations, and clinical criteria to and renders approval when appropriate + Extrapolates and summarizes medical information for review by Medical Director, as needed + Balances the need to produce high quality work with meeting timeframes and production goals 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:** + Active, unrestricted RN license in state of residence + 5+ years of clinical experience as an RN including in an acute, inpatient hospital setting + Experience applying benefits and criteria to clinical review + Utilization Management, pre-authorization, concurrent review or appeals experience + Solid computer skills including proficiency in Microsoft Office Word, Outlook, and Internet applications + Ability to access multiple computer platforms + Access to install secure high-speed internet (minimum speed 5 download mps & 1 upload mps) via cable/DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement) + Designated quiet workspace in your home (separated from non-workspace areas) and able to be secured to maintain Protected Health Information (PHI) and/or Protected Information (PI) + Ability to work 9am-6pm CST **Preferred Qualifications:** + Bachelor of Science in Nursing + Medical Coding experience/knowledge + Experience using Interqual + Experience with the following systems: UNET, iCUE/HSR, ATS, ETS or Cirrus + Experience analyzing medical records, benefit plans, medical policies and other various criteria + Demonstrated ability to work independently with solid self-discipline and time management skills + Demonstrated excellent communication, interpersonal, problem-solving, and analytical skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _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._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

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 to start Caring. Connecting. Growing together. 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). You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Review medical records and verify if the requested service meets criteria * Review pre-service appeals 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 * Accurately documenting determinations * Adherence to all confidentiality regulations and agreements * Hours M-F 8a-5p with alternating Saturdays * Comfortable working mandatory overtime 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: * Active, unrestricted RN license in state of residence * 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting * Proficiency in Microsoft Office, Word, Outlook, and Internet applications * Available M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday) Preferred Qualifications: * Bachelor of Science in Nursing * 1+ years of experience using MCG and/or Medicare criteria * 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience * Appeals experience * Proven excellent communication, interpersonal, problem-solving, and analytical skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits re subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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 to start Caring. Connecting. Growing together. If you are located within Eastern Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST. Primary Responsibilities: * Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid * Identify if additional information is required to process an appeal * Ability to adapt to changes that require cross training on appeal types as they are identified * Ability to work independently * Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision on administrative nurse level cases * Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities 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: * Current, valid, and unrestricted RN licensure in your state of residence * 2+ years of clinical experience in an acute care or an outpatient setting * 1+ years of direct experience within one (or more) of the following areas: * Utilization Review * Medicaid and/or Medicare appeals experience * LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC * Proven experience/understanding of billable services and claims in a managed care environment * Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills * Access to high-speed internet * Ability to work 8-5 within EST (Eastern standard time zone) Preferred Qualifications: * 5+ years of Medical Appeal experience working with Medicare and Medicaid * Solid coding experience or Certified Coder (CPC) * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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 to start Caring. Connecting. Growing together. As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims. Primary Responsibilities: * Review provider post-service appeals for Medicare and Retirement * Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines * Discuss cases with medical directors when applicable * Ability to communicate and collaborate with other teams in order to gather medical information to process cases * Communicate effectively in both verbal and written documentation * Must meet quality and productivity metrics * Ability to work independently and prioritize * Attend mandatory trainings and scheduled staff meetings * Engage in respectful and courteous team dialog via email, IM and in staff meeting 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: * Undergraduate degree or equivalent experience * Unrestricted, active RN license * 2+ years of RN experience in acute setting * Proven working knowledge of Clinical Criteria and CMS Guidelines/InterQual * Proven proficiency in basic computer skills * Demonstrated ability to have high speed internet installed in home for Secure Job use only * Proven designated HIPPA compliant home workspace Preferred Qualifications: * Undergraduate degree (BSN) * Proven utilization management, prior authorization, case management or prior appeals experience * Proven claims and coding experience Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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 to start **Caring. Connecting. Growing together.** As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims. **Primary Responsibilities:** + Review provider post-service appeals for Medicare and Retirement + Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines + Discuss cases with medical directors when applicable + Ability to communicate and collaborate with other teams in order to gather medical information to process cases + Communicate effectively in both verbal and written documentation + Must meet quality and productivity metrics + Ability to work independently and prioritize + Attend mandatory trainings and scheduled staff meetings + Engage in respectful and courteous team dialog via email, IM and in staff meeting 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:** + Undergraduate degree or equivalent experience + Unrestricted, active RN license + 2+ years of RN experience in acute setting + Proven working knowledge of Clinical Criteria and CMS Guidelines/InterQual + Proven proficiency in basic computer skills + Demonstrated ability to have high speed internet installed in home for Secure Job use only + Proven designated HIPPA compliant home workspace **Preferred Qualifications:** + Undergraduate degree (BSN) + Proven utilization management, prior authorization, case management or prior appeals experience + Proven claims and coding experience Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _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._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

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 to start **Caring. Connecting. Growing together.** 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). You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Review medical records and verify if the requested service meets criteria + Review pre-service appeals 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 + Accurately documenting determinations + Adherence to all confidentiality regulations and agreements + Hours M-F 8a-5p with alternating Saturdays + Comfortable working mandatory overtime 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:** + Active, unrestricted RN license in state of residence + 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting + Proficiency in Microsoft Office, Word, Outlook, and Internet applications + **Available M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday)** **Preferred Qualifications:** + Bachelor of Science in Nursing + 1+ years of experience using MCG and/or Medicare criteria + 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience + Appeals experience + Proven excellent communication, interpersonal, problem-solving, and analytical skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits re subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _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._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

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 to start **Caring. Connecting. Growing together.** If you are located within Eastern Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST. **Primary Responsibilities:** + Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid + Identify if additional information is required to process an appeal + Ability to adapt to changes that require cross training on appeal types as they are identified + Ability to work independently + Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision on administrative nurse level cases + Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities 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:** + Current, valid, and unrestricted RN licensure in your state of residence + 2+ years of clinical experience in an acute care or an outpatient setting + 1+ years of direct experience within one (or more) of the following areas: + Utilization Review + Medicaid and/or Medicare appeals experience + LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC + Proven experience/understanding of billable services and claims in a managed care environment + Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills + Access to high-speed internet + Ability to work 8-5 within EST (Eastern standard time zone) **Preferred Qualifications:** + 5+ years of Medical Appeal experience working with Medicare and Medicaid + Solid coding experience or Certified Coder (CPC) *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _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._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._