**Requisition number:** 2361533
**Job category:** Nursing

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together**

This position provides clinical oversight and quality review of 1) Appeal submissions prepared by review partners for escalation to the CMS Independent Review Entity (IRE) on behalf of UHC Payment Integrity, 2) Review partner oversight of Facility DRG audits for coding and clinical accuracy and consistency 3) Review partner oversight of Home Health, Skilled Nursing claims audits, and 4) Oversight of cost outlier audits. The role ensures that clinical arguments are accurate, complete, and defensible, with medical ...