Remote Utilization Management RN – Impactful Care

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

Job summary

Optum, part of UnitedHealth Group, is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters per guidelines. You will extract data, reference national criteria, and ensure accuracy and compliance.

The role requires RN licensure, a relevant associate degree, and 3+ years bedside nursing (ED/Telemetry/ICU/CCU). Telecommuting is allowed within the U.S. and the schedule is Monday–Friday, 40 hours.

Qualifications

• Associate's degree required and RN license in your state
• 3+ years of bedside nursing experience in ED/telemetry/ICU/CCU
• Proficiency with Microsoft applications and software, internet navigation and utilization
• Ability to type 45 wpm

Responsibilities

• Compose appeal letters with data extraction and use of templates, ensuring proper grammar and references to medical literature
• Understand and comply with HIPAA confidentiality requirements
• Support and promote OPAS, Optum, and enterprise goals and mission
• Build relationships across Optum, OPAS, OGA and clients
• Collaborate with peers to ensure continuity of communication and delivery of results
• Maintain quality and productivity and participate in meetings
• Stay up to date with required licenses and training
• Work independently with initiative and a collaborative team attitude

Skills

Microsoft applications

Typing 45 wpm

Bedside nursing experience (ED/telemet

Education

Associate's degree

Tools

InterQual

MCG

Microsoft Word

Job description

Optum, part of UnitedHealth Group, is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters per guidelines. You will extract data, reference national criteria, and ensure accuracy and compliance.

The role requires RN licensure, a relevant associate degree, and 3+ years bedside nursing (ED/Telemetry/ICU/CCU). Telecommuting is allowed within the U.S. and the schedule is Monday–Friday, 40 hours.