Remote Utilization Management Nurse RN – Appeals & Review

Registered Nurse; Northern (KY); On-site; USD 60,000 - 107,000; Full time

Job summary

Optum is a global organization delivering care aided by technology to help millions live healthier lives. The Utilization Management Nurse role includes reviewing medical records, drafting defensible appeal letters, and complying with HIPAA and company policies.

Telecommute options are available within the United States. Primary responsibilities include data extraction, template-based letters, and collaboration across Optum and OPAS teams.

Qualifications

• 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 with data extraction and templates.
• Adheres to 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 delivery of results.
• Adheres to quality and productivity expectations.
• Participate in and contribute to meetings as appropriate.
• Maintains organization on the team and ensures professional conduct.
• Stays up to date with all learning modules, competencies, and state required licenses.
• Performs other related duties as required.

Skills

Bedside nursing experience

Microsoft applications

Typing 45 wpm

Education

Associate's degree

Tools

InterQual

MCG

Job description

Optum is a global organization delivering care aided by technology to help millions live healthier lives. The Utilization Management Nurse role includes reviewing medical records, drafting defensible appeal letters, and complying with HIPAA and company policies.

Telecommute options are available within the United States. Primary responsibilities include data extraction, template-based letters, and collaboration across Optum and OPAS teams.