Per Diem Utilization Management Registered Nurse

UnitedHealth Group; Newtown Square (Delaware County); Remote; USD 40,000 - 72,000; Full time

Benefits offered by this job

Telecommuting

Flexible start times

Per diem schedule

Job summary

UnitedHealth Group is seeking an Utilization Management Nurse to review medical records, extract case details, and craft defensible appeal letters according to policy guidance. The role emphasizes timely, accurate reviews and HIPAA compliance while supporting OPAS and Optum goals.

The position offers Per Diem scheduling with flexible start times and the option to telecommute from anywhere in the United States. Strong nursing experience and MS Office proficiency are required.

Qualifications

• Associate's degree and RN licensure required.
• 3+ years of bedside nursing experience in ED/ICU/telemetry preferred.
• Proficiency in Microsoft Office and internet/navigation.
• Ability to type 45 words per minute.

Responsibilities

• Compose appeal letters with data extraction and templates following guidelines.
• Ensure HIPAA confidentiality and compliance with policies.
• Support OPAS, Optum, and enterprise goals.
• Build relationships across Optum, OPAS, OGA and clients.
• Collaborate to ensure continuity of communication and deliverables.
• Maintain quality and productivity; participate in meetings.
• Stay current with learning modules and licenses.
• Prioritize, work independently, and follow instructions with supervision.
• Maintain professional behavior within the team.
• Contribute to continuous improvement and other duties as needed.

Skills

Registered Nurse license

Bedside nursing

Microsoft Office

Typing 45 wpm

Education

Associate's degree

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Utilization Management Nurse will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department's/company's guidance. The nurse will complete their case within the time expectations while providing high quality reviews. The Utilization Management Nurse will perform their job functions, adhering to both Optum and OPAS policies and procedures, which include but are not limited to the following.

Schedule:

Per Diem as needed, flexible start times

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Follows directive of composing appeal letters to include appropriate data extraction, construction of well-written appeals letters with proper grammar, utilization of appeal tools including pre-constructed templates, inclusion of appropriate medical literature references, and use of national criteria guidelines. Adheres to company policies and procedures as well as policies, procedures, and laws
• Understands and complies with HIPAA confidentiality requirements
• Support and promote OPAS, Optum, and the enterprise goals and mission
• Build relationships across Optum, OPAS, OGA and our clients
• Collaborate with peers to assure continuity of communication and execution of deliverables as needed
• Adheres to quality and productivity expectations
• Participate in and contribute to meetings as appropriate
• Maintains organization on the team and ensures everyone conducts themselves professionally
• Remains up to date with all learning modules, competencies, and state required licenses
• Performs other related duties, tasks, and processes as required by leadership
• Ability to establish priorities, be self-motivated, work independently, and follow instructions with supervision and structure
• Positive attitude and the ability to function as a collaborative team member

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Associate's degree
• Unrestricted Registered Nurse License in your state of residence
• 3+ years of bedside nursing experience in ED/telemetry/ICU/CCU
• Advanced level of proficiency with Microsoft applications and software, internet navigation and utilization
• Ability to type 45 wpm

Preferred Qualifications:

• Working knowledge of Word
• Effective communication skills
• Excellent typing skills with a minimum speed of 45/min
• Solid, effective verbal and written communication skills

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

#RPO #GREEN