Remote RN: Utilization Management & Clinical Validation

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

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase program

401k contribution

Job summary

UnitedHealth Group/Optum seeks an Utilization Management & Clinical Validation RN to review medical records, extract case details, and craft defensible appeal letters. Telecommute from anywhere in the U.S. with guidance from policies and coding guidelines.

Role emphasizes HIPAA compliance, coding knowledge, and collaboration for quality outcomes. Requirements include an RN license, associate degree or higher, 3+ years in ED/Telemetry/Critical Care, and 2+ years in clinical validation appeals.

Qualifications

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

Responsibilities

• Review and extract pertinent case details from patient medical records.
• Craft appeal letters with data extraction and evidence-based references.
• Utilize encoders, coding clinics, ICD-9/10, CM, PCS, CPT, and HCPCS guidelines.
• Follow HIPAA confidentiality requirements and company policies.
• Collaborate with team to ensure continuity of communication and deliverables.

Skills

Effective communication

45 wpm typing

Word proficiency

Time management

Team collaboration

Education

Associate degree or higher

Tools

Verint

HR Direct

Microsoft Word

Encoders

Job description

UnitedHealth Group/Optum seeks an Utilization Management & Clinical Validation RN to review medical records, extract case details, and craft defensible appeal letters. Telecommute from anywhere in the U.S. with guidance from policies and coding guidelines.

Role emphasizes HIPAA compliance, coding knowledge, and collaboration for quality outcomes. Requirements include an RN license, associate degree or higher, 3+ years in ED/Telemetry/Critical Care, and 2+ years in clinical validation appeals.