Remote Utilization Management Nurse RN | Appeals & Reviews

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

Job summary

UnitedHealth Group is seeking an Utilization Management Nurse to review medical records, extract case details, and craft appeal letters. The role follows HIPAA rules and company policies while supporting OPAS and Optum goals. Telecommute from anywhere in the U.S.

with a Monday–Friday schedule and possible after-hours coverage. Requirements include an Associate's degree, an unrestricted RN license, 3+ years bedside nursing in adult ED/telemetry/ICU/CCU, and proficiency in Microsoft tools.

Qualifications

• Associate's degree required for the role.
• Unrestricted RN license in the state of residence.
• At least 3+ years bedside nursing in adult ED/telemetry/ICU/CCU.
• High proficiency with Microsoft applications and general software.
• Ability to type 45 wpm.

Responsibilities

• Review medical records and extract pertinent case details.
• Craft defensible appeal letters per process and guidance.
• Adhere to HIPAA and privacy requirements.
• Support OPAS and enterprise goals and collaborate across teams.
• Maintain quality, productivity, and professional conduct.

Skills

Nursing experience

HIPAA knowledge

MS Office proficiency

Typing speed 45 wpm

Independent work habit

Education

Associate's degree

Unrestricted RN license

Tools

InterQual

MCG

Job description

UnitedHealth Group is seeking an Utilization Management Nurse to review medical records, extract case details, and craft appeal letters. The role follows HIPAA rules and company policies while supporting OPAS and Optum goals. Telecommute from anywhere in the U.S.

with a Monday–Friday schedule and possible after-hours coverage. Requirements include an Associate's degree, an unrestricted RN license, 3+ years bedside nursing in adult ED/telemetry/ICU/CCU, and proficiency in Microsoft tools.