Remote RN: Utilization & Clinical Validation Specialist

Texas Health Institute; Northern (KY); Hybrid; USD 60,000 - 107,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

Optum is a global organization that delivers care, aided by technology to help millions live healthier lives. The Utilization Management & Clinical Validation RN role involves reviewing medical records, extracting pertinent details, and crafting evidence-based appeal letters per guidelines.

You will enjoy telecommuting from anywhere in the U.S. The salary range for this full-time position is $60,200 to $107,400 annually, with comprehensive benefits and opportunities for career development.

Qualifications

• Associates degree or higher
• Unrestricted RN license required in state of residence
• 3+ years of Clinical experience in ED/Telemetry/Critical Care
• 2+ years of experience in clinical validation appeals

Responsibilities

• Review and extract pertinent case details from patient medical records
• Craft strongly defensible appeal letters per process instructions
• Utilize encoders and coding guidelines (ICD-9/10, CM/PCS, CPT, HCPCS)
• Recommend coding changes based on chart analysis
• Comply with HIPAA and organizational policies
• Collaborate with team to ensure timely delivery of deliverables

Skills

Excellent typing skills

Effective communication

HIPAA compliance

Independent worker

Time management

Education

Associates degree or higher

Tools

Verint

HR Direct

MS Word

Job description

Optum is a global organization that delivers care, aided by technology to help millions live healthier lives. The Utilization Management & Clinical Validation RN role involves reviewing medical records, extracting pertinent details, and crafting evidence-based appeal letters per guidelines.

You will enjoy telecommuting from anywhere in the U.S. The salary range for this full-time position is $60,200 to $107,400 annually, with comprehensive benefits and opportunities for career development.