Remote RN: Utilization Management & Appeals

ISHE; Northern (KY); Hybrid; USD 60,000 - 107,000; Full time

Job summary

Optum is a global organization dedicated to improving health outcomes through care and technology. The Utilization Management Nurse will extract details from patient records and craft persuasive appeal letters per guidelines, within required timeframes.

The role offers Monday–Friday, 40 hours weekly, with flexible start times and telecommuting from anywhere in the U.S. Compliance and collaboration across teams are emphasized.

Qualifications

• Associate degree required.
• Unrestricted RN license in your state of residence.
• 3+ years bedside nursing experience in adult ED/telemetry/ICU/CCU.
• Advanced proficiency with Microsoft applications and internet navigation.
• Ability to type 45 wpm.

Responsibilities

• Compose appeal letters with data extraction and template tools.
• Ensure HIPAA confidentiality and compliance with policies.
• Support OPAS, Optum, and enterprise goals.
• Collaborate across Optum and client teams to deliver results.
• Maintain professionalism and adhere to productivity expectations.

Skills

Typing 45 wpm

MS Office

Verbal and written communication

Education

Associate's degree

Tools

Microsoft Word

InterQual

MCG

Job description

Optum is a global organization dedicated to improving health outcomes through care and technology. The Utilization Management Nurse will extract details from patient records and craft persuasive appeal letters per guidelines, within required timeframes.

The role offers Monday–Friday, 40 hours weekly, with flexible start times and telecommuting from anywhere in the U.S. Compliance and collaboration across teams are emphasized.