Remote Utilization Management Nurse (RN) – Appeals

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

Benefits offered by this job

Comprehensive benefits

401k contribution

Job summary

UnitedHealth Group's Optum is seeking a Utilization Management Nurse to review patient records and craft defensible appeal letters in accordance with OPAS guidelines. This role supports 40 hours per week, Monday–Friday, with telecommuting flexibility across the U.S.

and a strong emphasis on data-driven, compliant reviews. The position requires an RN license and an associate degree, plus 3+ years of bedside nursing in ED/telemetry/ICU/CCU.

Qualifications

• Associate's degree required
• Unrestricted RN license in your state of residence
• 3+ years bedside nursing experience in ED/telemetry/ICU/CCU
• Proficiency with Microsoft Office and internet navigation
• Typing speed 45 wpm

Responsibilities

• Review patient medical records and extract pertinent details for appeals
• Draft defensible appeal letters with supporting data and literature
• Ensure HIPAA confidentiality and comply with policies
• Collaborate with OPAS, Optum and clients to meet quality standards
• Maintain organization and professional conduct within the team
• Stay up-to-date with required licenses and learning modules
• Support meetings and contribute to deliverables as needed

Skills

Strong verbal and written沟通

Independent work capability

Typing 45 wpm

Education

Associate's degree

Tools

Microsoft Office

Word

Job description

UnitedHealth Group's Optum is seeking a Utilization Management Nurse to review patient records and craft defensible appeal letters in accordance with OPAS guidelines. This role supports 40 hours per week, Monday–Friday, with telecommuting flexibility across the U.S.

and a strong emphasis on data-driven, compliant reviews. The position requires an RN license and an associate degree, plus 3+ years of bedside nursing in ED/telemetry/ICU/CCU.