Job: Clinical Appeals Reviewer - Houston, TX

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Jobing Description

Position Description:
Positions in this function are responsible for providing expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. Communicates with appropriate parties issues, implications and decisions. Analyzes and identifies trends for appeals and grievances. This includes senior level positions with education/certification/licensure other than an RN, such as BSW, MSW, DDS, Chiropractor, Physical Therapist, etc.

Primary Responsibilities:

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  Work is frequently completed without established procedures.
  


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  Works independently.
  


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  May act as a resource for others.
  


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  May coordinate others activities.
  


• 
  
  Work is frequently completed without established procedures.
  


• 
  
  Works independently.
  


• 
  
  May act as a resource for others.
  


• 
  
  May coordinate others activities.
  

OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.

Skills / Requirements

Requirements:

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  High School Diploma
  


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  Proficient Computer Skills
  


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  1+ year of manage care experience required.
  

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.