Remote Utilization Management RN - Clinical Validation

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

Benefits offered by this job

Telecommute from anywhere in the U.S.

Job summary

Optum is seeking a Utilization Management & Clinical Validation RN to review medical records, extract case details, and craft defensible appeal letters using evidence-based literature. You will utilize coding guidelines and communicate effectively with teams across the organization.

The role offers telecommuting from anywhere in the U.S. and requires HIPAA compliance, strong typing, and independent work ethos. Salary ranges are based on experience and location.

Qualifications

• Associates degree or higher required.
• Unrestricted RN license in resident state required.
• 3+ years clinical experience in ED/Telemetry/Critical Care.
• 2+ years experience in clinical validation appeals.

Responsibilities

• Review and extract pertinent case details from patient medical records.
• Craft defensible appeal letters per process instructions and guidelines.
• Use encoders and coding references (ICD-9/10, CM/PCS, CPT, HCPCS).
• Draft letters with data extraction and literature citations.

Skills

Typing speed

Effective communication

Prioritization

Independent work

Team collaboration

HIPAA compliance

Adaptability

Education

Associates degree or higher

RN license (unrestricted)

Clinical experience in ED/Telemetry/CCU

Clinical validation appeals experience

Tools

Word

Job description

Optum is seeking a Utilization Management & Clinical Validation RN to review medical records, extract case details, and craft defensible appeal letters using evidence-based literature. You will utilize coding guidelines and communicate effectively with teams across the organization.

The role offers telecommuting from anywhere in the U.S. and requires HIPAA compliance, strong typing, and independent work ethos. Salary ranges are based on experience and location.