Flexible Schedule Job Clinical Appeals RN – IG Therapy / Biologics – Remote-id-9256

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Position: Clinical Appeals Nurse – Home Infusion (IG Therapy / Biologics)

Location: Remote (Anywhere in the U.S.)
Schedule: Monday – Friday, 8:30 AM – 5:30 PM CST
Hourly Pay Range: $28.61 – $56.06 (based on experience, location, and qualifications)

About Optum and UnitedHealth Group

Optum is a global leader in healthcare innovation, committed to improving health outcomes by connecting people with care, pharmacy benefits, data, and resources. UnitedHealth Group values diversity, inclusion, and career development, offering a culture where you can grow and truly impact the communities we serve. Join us as we advance health equity and transform healthcare.

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Role Overview

As a Home Infusion Clinical Appeals Nurse, you will use your clinical expertise to review infusion therapy treatment protocols, ensuring they meet patient needs and comply with payer requirements. You will collaborate closely with physicians, clinics, and patients to support appeals processes, advocating for patient access to complex infusible medications. This is a key role on a dynamic, multidisciplinary team focused on delivering safe, effective home-based infusion care.

What You’ll Do

  • Review patient data and care histories; prepare and submit detailed appeals letters/emails to payers

  • Build and maintain relationships with physicians, clinics, and patients to ensure patient-centered care

  • Facilitate resolution of coverage and treatment authorization requests

  • Advocate on behalf of patients to resolve coverage denials and ensure access to necessary therapies

  • Participate in committees and process improvement initiatives to enhance patient outcomes and satisfaction

Required Qualifications

  • Active RN license in state of residence

  • 3+ years’ experience with clinical appeals, grievances, and post-payment reviews

  • 2+ years’ clinical infusion experience (e.g., immunoglobulin therapy, biologics)

  • Strong knowledge of autoimmune, primary immune, and inflammatory diseases

  • Familiarity with clinical documentation from physician offices and telephonic assessments

  • Proficiency with Microsoft Outlook, Word, Excel, and SharePoint

Preferred Qualifications

  • Bachelor’s degree in nursing or related field

  • Experience with CPR+ software

  • Previous remote Clinical Appeals RN experience

  • Expertise with infusion therapy approvals/denials and health insurance plan language

  • Understanding of payer reimbursement structures, Medicare/Medicaid payment systems

  • Advanced computer skills in a paperless environment

Why Work with Us?

  • Competitive pay with bonus and incentive programs

  • Comprehensive benefits including medical, dental, vision, 401(k), and employee stock purchase

  • Flexible remote work opportunity with a collaborative and mission-driven team

  • Career growth and development opportunities in a leading healthcare organization

Equal Opportunity & Additional Info

UnitedHealth Group is an Equal Employment Opportunity employer committed to diversity and inclusion. All applicants will be considered without regard to protected characteristics. This position requires a drug test before employment.

Ready to make a difference? Apply now to join an elite team shaping the future of home infusion care!

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