Use your clinical expertise to shape healthcare policies that impact millions. This role focuses on researching, maintaining, and auditing medical policies for Medicaid programs while ensuring compliance and accuracy in coding and reimbursement.
About UnitedHealthcare / Optum
UnitedHealthcare, part of UnitedHealth Group, is dedicated to simplifying healthcare, improving access, and removing barriers to quality care. Their work supports healthier communities nationwide while giving employees opportunities for growth and impact.
Schedule
- Full-time, Monday – Friday
- Remote flexibility across the U.S.
- Standard business hours with project-based assignments
What You’ll Do
- Research and maintain medical policies for Medicaid lines of business
- Conduct clinical research and support value-creation projects
- Audit CPT, HCPCS, and ICD-10 coding for compliance in policy documents
- Lead cross-functional discussions on clinical topics and present findings in group settings
- Develop solutions for complex issues and provide expert-level guidance
What You Need
- Registered Nurse (RN) license
- 3+ years of experience with managed care organizations or health insurers
- Medicaid experience in Prior Authorizations, Appeals, Claims, or Medical Policy
- Knowledge of InterQual guidelines
Preferred Qualifications
- Certified coder (AAPC or AHIMA)
- 3+ years of direct Medicaid experience in policy or claims functions
- Experience writing policies or SOPs
- Strong skills in MS Word and PowerPoint
- Proven attention to detail, communication, and critical thinking
Benefits
- Pay range: $16.00 – $20.43 per hour (based on experience and location)
- Comprehensive medical, dental, and vision coverage
- 401(k) with company match and stock purchase plan
- Paid time off, recognition programs, and career development opportunities
Contribute your expertise in policy and compliance to help build a more equitable healthcare system.
Happy Hunting,
~Two Chicks…