Remote Utilization Management Nurse – Appeals Specialist

NHSHP; Northern (KY); Hybrid; USD 40,000 - 72,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase

401k contribution

Job summary

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Utilization Management Nurse role focuses on reviewing medical records and crafting defensible appeal letters under policy guidance, with flexible per-diem scheduling and telecommuting options within the U.S.

You will work to comply with HIPAA, collaborate across teams, and maintain high-quality reviews.

Qualifications

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

Responsibilities

• Review and extract pertinent case details from patient medical records.
• Craft defensible appeal letters with pre-constructed templates and literature references.
• Adhere to HIPAA and company policies and procedures.
• Collaborate with peers to ensure quality and timely deliverables.

Skills

Microsoft applications proficiency

Typing 45 wpm

HIPAA compliance

Independent work

Team collaboration

Education

Associate's degree

Tools

Microsoft Office

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Utilization Management Nurse role focuses on reviewing medical records and crafting defensible appeal letters under policy guidance, with flexible per-diem scheduling and telecommuting options within the U.S.

You will work to comply with HIPAA, collaborate across teams, and maintain high-quality reviews.