Remote Utilization Management RN-Clinical Validation Expert

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

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase plan

401(k) contribution

Telecommuting policy

Job summary

UnitedHealth Group is hiring a Utilization Management & Clinical Validation RN. This remote role involves reviewing medical records, extracting case details, and crafting evidence-based appeal letters.

You will use coding guidelines and literature to support decisions and ensure compliance with HIPAA and company policies. The position requires an unrestricted RN license, 3+ years in ED/Telemetry/CCU, and 2+ years in clinical validation appeals.

Qualifications

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

Responsibilities

• Review and extract pertinent case details from patient medical records
• Craft defensible appeal letters with data extraction and medical literature references
• Apply ICD-9/10, CM/PCS, CPT and HCPCS guidelines
• Adhere to HIPAA confidentiality and company policies
• Collaborate with peers to ensure accuracy and timely deliverables

Skills

Effective communication

Typing speed 45+/min

HIPAA confidentiality

Self-motivated

Team collaboration

Education

Associates degree or higher

Tools

Verint

HR Direct

Microsoft Word

Job description

UnitedHealth Group is hiring a Utilization Management & Clinical Validation RN. This remote role involves reviewing medical records, extracting case details, and crafting evidence-based appeal letters.

You will use coding guidelines and literature to support decisions and ensure compliance with HIPAA and company policies. The position requires an unrestricted RN license, 3+ years in ED/Telemetry/CCU, and 2+ years in clinical validation appeals.