Remote Utilization Management Nurse RN - Appeals Specialist

UnitedHealth Group; Newtown Square (Delaware County); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401(k) contribution

Job summary

UnitedHealth Group’s Optum is seeking an Utilization Management Nurse to review medical records, extract case details, and craft defensible appeal letters under policy guidance. The role supports telecommuting within the United States and follows a Monday–Friday schedule.

The ideal candidate holds an Associate’s degree, an unrestricted RN license, 3+ years bedside nursing in acute settings, and proficiency with Microsoft Office and typing 45 wpm.

Qualifications

• Associate's degree required and RN license in state of residence.
• 3+ years bedside nursing experience in adult ED/ICU/Telemetry.
• Proficiency with Microsoft applications and ability to type 45 wpm.
• HIPAA confidentiality knowledge and compliance required.

Responsibilities

• Review patient records and extract pertinent case details for appeals.
• Craft defensible appeal letters with data and literature references.
• Follow policies, procedures and HIPAA requirements consistently.
• Collaborate with OPAS, Optum and clients to ensure deliverables.
• Maintain organization, attention to quality and productivity.
• Stay current with learning modules and required licenses.

Skills

Bedside nursing experience

HIPAA compliance

Microsoft Office proficiency

Typing 45 wpm

Education

Associate's degree

Tools

Microsoft Word

Job description

UnitedHealth Group’s Optum is seeking an Utilization Management Nurse to review medical records, extract case details, and craft defensible appeal letters under policy guidance. The role supports telecommuting within the United States and follows a Monday–Friday schedule.

The ideal candidate holds an Associate’s degree, an unrestricted RN license, 3+ years bedside nursing in acute settings, and proficiency with Microsoft Office and typing 45 wpm.