Remote Utilization Management Nurse RN — Appeals

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

Job summary

Optum is a global health services company seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters per policy and guidelines. This role emphasizes data extraction, accuracy, and adherence to national criteria.

The position offers Monday–Friday, 40 hours weekly with flexible start times and telecommuting from anywhere in the U.S. The ideal candidate holds an Associate's degree, an unrestricted RN license, and 3+ years of bedside nursing in acute care

Qualifications

• Associate's degree
• Unrestricted Registered Nurse license in your state of residence
• 3+ years of bedside nursing experience in adult ED/telemetry/ICU/CCU
• Advanced level of proficiency with Microsoft applications and software, internet navigation and utilization
• Ability to type 45 wpm

Responsibilities

• Follows directive of composing appeal letters to include appropriate data extraction, construction of well-written appeals letters with proper grammar, utilization of appeal tools including pre-constructed templates, inclusion of appropriate medical literature references, and use of national criteria guidelines.
• Understands and complies with HIPAA confidentiality requirements
• Support and promote OPAS, Optum, and the enterprise goals and mission
• Build relationships across Optum, OPAS, OGA and our clients
• Collaborate with peers to assure continuity of communication and execution of deliverables as needed
• Adheres to quality and productivity expectations
• Participate in and contribute to meetings as appropriate
• Maintains organization on the team and ensures everyone conducts themselves professionally
• Remains up to date with all learning modules, competencies, and state required licenses
• Performs other related duties, tasks, and processes as required by leadership
• Ability to establish priorities, be self-motivated, work independently, and follow instructions with supervision and structure
• Positive attitude and the ability to function as a collaborative team member

Education

Associate's degree

Job description

Optum is a global health services company seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters per policy and guidelines. This role emphasizes data extraction, accuracy, and adherence to national criteria.

The position offers Monday–Friday, 40 hours weekly with flexible start times and telecommuting from anywhere in the U.S. The ideal candidate holds an Associate's degree, an unrestricted RN license, and 3+ years of bedside nursing in acute care