Remote Utilization Management Nurse RN – Appeals & Case Review

Palo Verde Community College District; Northern (KY); Hybrid; USD 60,000 - 107,000; Full time

Job summary

Optum is a global health services organization delivering care aided by technology. The Utilization Management Nurse will review patient records and craft defensible appeal letters, adhering to HIPAA and department guidelines.

You will manage time effectively, ensuring high-quality reviews and data extraction. The role offers a Mon–Fri schedule (40 hours/week) with flexible start times and remote work from anywhere in the United States.

Qualifications

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

Responsibilities

• Compose appeal letters with data extraction and templates, ensuring proper grammar and references.
• Comply with HIPAA confidentiality requirements.
• Support and promote OPAS, Optum, and enterprise goals.
• Collaborate across Optum, OPAS, OGA and clients for continuity of communication and deliverables.
• Maintain quality and productivity, participate in meetings, and stay updated on licenses and learning modules.

Skills

Typing 45 wpm

Strong communication

Education

Associate's degree

Tools

Microsoft Office

Job description

Optum is a global health services organization delivering care aided by technology. The Utilization Management Nurse will review patient records and craft defensible appeal letters, adhering to HIPAA and department guidelines.

You will manage time effectively, ensuring high-quality reviews and data extraction. The role offers a Mon–Fri schedule (40 hours/week) with flexible start times and remote work from anywhere in the United States.