Remote RN: Utilization Management & Clinical Validation

University of Minnesota School of Nursing; Northern (KY); Hybrid; USD 60,000 - 107,000; Full time

Benefits offered by this job

Telecommuting policy

Benefits package

Incentive programs

Stock purchase plan

401k contribution

Job summary

UnitedHealth Group is seeking a Utilization Management & Clinical Validation RN to review and extract pertinent case details from patient medical records and craft defensible appeal letters per process instructions and literature.

The role supports telecommuting from anywhere in the U.S., requires an RN license, an associate degree or higher, and 3+ years of ED/Telemetry/Critical Care experience with 2+ years in clinical validation appeals.

Qualifications

• Unrestricted RN license required in state of residence.
• Associates degree or higher.
• 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 records.
• Craft defensible appeal letters with data extraction and literature references.
• Use encoders and coding guidelines (ICD-9/10, CM/PCS, CPT, HCPCS).
• Adhere to HIPAA and company policies; maintain professional communication.

Skills

RN licensure

Clinical validation

Documentation

Typing speed

Education

Associate degree or higher

Job description

UnitedHealth Group is seeking a Utilization Management & Clinical Validation RN to review and extract pertinent case details from patient medical records and craft defensible appeal letters per process instructions and literature.

The role supports telecommuting from anywhere in the U.S., requires an RN license, an associate degree or higher, and 3+ years of ED/Telemetry/Critical Care experience with 2+ years in clinical validation appeals.