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  • Lenexa, KS

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Clinical Appeals Nurse, RN - Home Infusion - Lenexa, KS

UnitedHealth Group • Lenexa, KS

Posted 16 days ago

Job Snapshot

Healthcare - Health Services
Health Care, Nurse


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Job Description

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. If you want to achieve more in your mission of healthcare, you have to be really smart about the business of healthcare. Challenge yourself, your peers, and our industry by shaping what healthcare looks like and doing your life's best work.(sm)

UnitedHealth Group is seeking talented individuals for our Home Infusion Clinical Appeals Nurse opportunities. You will be able to use your talents and experience to analyze proposed treatment protocols to ensure their appropriateness and responsiveness to patient needs and to provide clinical support for writing appeals for patients requiring complex infusible medications.  Our elite team of Clinical Appeals Nurses is growing and we want YOU to join this dynamic and exciting group.

We are now BriovaRx Infusion Services, and we recently joined Optum, part of the UnitedHealth Group family of companies.

Benefits include:

  • Competitive compensation

  • 100% office based, Monday through Friday 9:00 AM to 6:00 PM schedule

  • The satisfaction that comes with knowing your effort allows patients to receive the care they need!

  • The opportunity to influence change with medical policies and coverage criteria

The Home Infusion Clinical Appeals Nurse fills an integral role in the clinical and intake operations of the organization, working collaboratively with a multi - disciplinary team to ensure infusion therapy can be safely and effectively administered to each home - based patient.


Primary Responsibilities:

  • Document patient demographic data, synopsis of care history, and compose letters or e - mails to payers with proposed treatment plan in accordance with health plan requirements

  • Develop a consultant relationship with assigned physicians / clinics / patients to build and sustain a patient - focused approached to care

  • Facilitate resolution of treatment requests for assigned patients

  • Advocates patient viewpoints to payers on decisions directly affecting coverage - related concerns

  • Participate on committees, work groups, and / or process improvement teams that improve patient outcomes and satisfaction

Required Qualifications:

  • Licensed Registered Nurse (RN) in the state of Kansas, or have the ability to obtain licensure

  • 2+ years’ clinical experience as a Registered Nurse

  • 2+ years’ experience in autoimmune, primary immune, and / or inflammatory disease states

  • Understanding of clinical documentation from physician offices and telephonic assessment notes of patients

Preferred Qualifications:

  • Bachelor’s degree

  • Home Infusion experience

  • Knowledge of specialty infusions such as IVIG and Remicade

  • Prior authorization, pre - certification, utilization review and / or appeals experience

  • Understanding of health insurance summary plan description language

  • Understanding of how payer reimbursements work, plus co - pays, co - insurances and deductibles

  • Understanding of government payment systems such as Medicare and Medicaid

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

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords:  Registered Nurse, Clinical Appeals, prior authorization, pre-certification, utilization review, case manager, specialty infusion, AxelaCare, Lenexa, KS, Kansas

Job ID: 2551_743174
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