Remote RN - Utilization Management & Clinical Appeals

Optum; Newtown Square (Delaware County); On-site; USD 60,000 - 107,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase program

401k contribution

Job summary

Optum is a global health services company seeking an RN in Utilization Management & Clinical Validation. This role supports evidence-based appeal letters, data extraction, and medical literature references. Proficiency with encoders and coding guidelines is required.

You will work remotely from anywhere in the United States with a flexible schedule, while upholding HIPAA, quality, and productivity standards and collaborating with Optum and OPAS teams.

Qualifications

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

Responsibilities

• Compose appeal letters with data extraction and literature references.
• Utilize encoders and coding guidelines (ICD-9/10, CM/PCS, CPT, HCPCS).
• Maintain HIPAA compliance and accurate time/attendance records.
• Collaborate with teams across Optum and clients to deliver results.

Skills

Typing speed

HIPAA compliance

Effective communication

Education

Associates degree or higher

RN license (unrestricted)

Tools

Word

Job description

Optum is a global health services company seeking an RN in Utilization Management & Clinical Validation. This role supports evidence-based appeal letters, data extraction, and medical literature references. Proficiency with encoders and coding guidelines is required.

You will work remotely from anywhere in the United States with a flexible schedule, while upholding HIPAA, quality, and productivity standards and collaborating with Optum and OPAS teams.