Remote RN: Utilization Management & Clinical Validation

Construction Association of Michigan; Northern (KY); Hybrid; USD 60,000 - 107,000; Full time

Benefits offered by this job

Telecommute

Benefits package

Equity stock plan

401k

Job summary

Optum is seeking an Utilization Management & Clinical Validation RN to review medical records and extract key details for strong appeal letters. You will use ICD coding and evidence-based references to support decisions while adhering to HIPAA and policy guidelines.

The role offers telecommuting flexibility within the U.S. and requires an RN license with 3+ years in ED/Telemetry/Critical Care, including 2+ years in clinical validation appeals.

Qualifications

• Associates degree or higher.
• Unrestricted RN license in state of residence.
• 3+ years 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 defensible appeal letters with data, literature references and coding guidance.
• Apply ICD-9/10, CM/PCS, CPT and HCPCS guidelines in chart reviews.
• Adhere to Optum and OPAS policies; maintain HIPAA confidentiality.

Skills

RN experience

HIPAA compliance

Education

Associates degree or higher

Job description

Optum is seeking an Utilization Management & Clinical Validation RN to review medical records and extract key details for strong appeal letters. You will use ICD coding and evidence-based references to support decisions while adhering to HIPAA and policy guidelines.

The role offers telecommuting flexibility within the U.S. and requires an RN license with 3+ years in ED/Telemetry/Critical Care, including 2+ years in clinical validation appeals.