Remote Utilization Management RN — Appeals Specialist

Texas Health Institute; Northern (KY); Hybrid; USD 60,000 - 107,000; Full time

Job summary

Optum is a global organization that delivers care with technology to help millions live healthier lives. The Utilization Management Nurse reviews patient records and crafts defensible appeal letters, adhering to HIPAA and company policies.

The role requires 3+ years of bedside nursing experience (ED/telemetry/ICU/CCU), an RN license, and proficiency with Microsoft Office. Flexible schedule; telecommute within the U.S. is available.

Qualifications

• Associate's degree required and RN license in your state of residence.
• 3+ years 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 enterprise goals.
• Build relationships across Optum, OPAS, OGA and clients.
• Collaborate to ensure communication and delivery of results.
• Maintain quality and productivity expectations.
• Participate in meetings and contribute to objectives.
• Stay up to date with training modules and licenses.

Skills

Bedside nursing

RN license

Typing 45 wpm

MS Office proficiency

Education

Associate's degree

Tools

Microsoft Office

Word

Job description

Optum is a global organization that delivers care with technology to help millions live healthier lives. The Utilization Management Nurse reviews patient records and crafts defensible appeal letters, adhering to HIPAA and company policies.

The role requires 3+ years of bedside nursing experience (ED/telemetry/ICU/CCU), an RN license, and proficiency with Microsoft Office. Flexible schedule; telecommute within the U.S. is available.