Senior Clinical Appeals - RN - Remote 2384307 | Plymouth, Minnesota | Remote

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Touch device users, explore by touch or with swipe gestures. Go Explore remote jobs Pursue your passion and potential Senior Clinical Appeals - RN - Remote Plymouth, Minnesota Apply Internal apply Bookmark job Jump to Our values Job description Benefits Testimonial Awards & recognitions Related content Caring. Connecting. Growing together. With these values to guide us, our people are committed to making a meaningful difference in the lives of those we are honored to serve. Integrity Compassion Inclusion Relationships Innovation Performance Back to nav Senior Clinical Appeals - RN - Remote Requisition number: 2384307 Job category: Nursing Primary location: Plymouth, Minnesota Date posted: 09/11/2026 Overtime status: Non-exempt Travel: No Share this job Facebook X LinkedIn Email Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Senior Clinical Appeals RN utilizes subject matter expertise in MS-DRG and APR-DRG auditing to review and provide response to appeals. By partnering with the original auditor, review medical records, and other information to author a rebuttal or agreement with the facility. This person will be instrumental in providing coaching and education to our remote DRG Validation Specialists utilizing core coding and clinical information. We are seeking self-motivated, solution-oriented and skilled problem solvers who provide written documentation under tight deadlines. As a Sr Clinical Appeals RN, you will derive key insights from the appeals and provide guidance and direction to fellow auditors across our business. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Analyze scope and resolution of DRG Appeals Respond to Level one, two or higher appeals Perform complex conceptual analyses Identify risk factors, comorbidities, and adverse events, to determine if overpayment or claim adjustment is needed Review governmental regulations and payer protocols and / or medical policy to recommend appropriate actions Research and prepare written appeals Exercise clinical and/or coding judgment and experience Collaborate with existing auditors, quality and leadership team to seek to understand, and review medical records pertaining to impacted claims Navigate through web-based portals and independently utilizes other online tools and resources including but not limited to word, adobe, excel Serve as a key resource on complex and / or critical issues and help develop innovative solutions Define and document / communicate business requirements 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: Unrestricted RN (registered nurse) license in your state of residence CCS or CIC certification or willing to obtain within 6 months of hire 2+ years of ICD -10-CM coding including but not limited to; knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM) 2+ years of ICD-10-PCS coding including but not limited to; knowledge of the structural components of PCS including but not limited to; selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers Preferred Qualifications: An existing coding certification, such as RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner), CCS (certified coding specialist), or CIC (certified inpatient coder) 3+ years of MS DRG/APR DRG coding experience in a hospital environment with knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies Managed care experience Healthcare claims experience Investigation and/or auditing experience Knowledge of health insurance business, industry terminology, and regulatory guidelines Proficiency with MS Excel, including the ability to create/edit spreadsheets and use sort/filter function *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 $35 - $63 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. Apply Internal apply Bookmark job Back to nav Benefits Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well. Life Resources and support to focus on what matters most to you, in every facet of your life. Emotional Education, tools and resources to help you reduce and manage stress, build resilience and more. Physical Health plans and other coverage to support wellness for you and your loved ones. Financial Benefits for today and to help you plan for the future, including your retirement. Learn more Back to nav Previous slide Being able to connect with so many people that all have the same goal in giving the best care possible is something truly special. Brooke G. Senior Pharmacy Technician At Optum, I receive the support, resources, and flexibility that I want so that I can be the best doctor possible while also finding personal and professional satisfaction. Dr. Conan T. Regional Chief of Primary Care We’re applying artificial intelligence to build something that can help people in their most distressed moments. The problems you work on here have an impact on someone’s life. Achala S. Senior Director and AI Architect Being able to connect with so many people that all have the same goal in giving the best care possible is something truly special. Brooke G. Senior Pharmacy Technician At Optum, I receive the support, resources, and flexibility that I want so that I can be the best doctor possible while also finding personal and professional satisfaction. Dr. Conan T. Regional Chief of Primary Care We’re applying artificial intelligence to build something that can help people in their most distressed moments. The problems you work on here have an impact on someone’s life. Achala S. Senior Director and AI Architect Being able to connect with so many people that all have the same goal in giving the best care possible is something truly special. Brooke G. Senior Pharmacy Technician Next slide Go to slide 1 Go to slide 2 Go to slide 3 Back to nav We’re honored to be recognized for our exceptional work culture Back to nav Discover our family of businesses See how we’re structured to help build a modern, high-performing health system. Learn more Explore our hiring process Learn what to expect when you pursue an opportunity with us. Learn more How we’re transforming care Find out how we’re making care smarter and more personalized. 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