Remote Utilization Review RN: Appeals & Care Optimization

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

Benefits offered by this job

Telecommute from anywhere in the U.S.

Comprehensive benefits package

Incentive and recognition programs

Job summary

Optum is a global healthcare organization empowering care through technology. The Utilization Management Nurse role involves reviewing medical records, extracting case details, and crafting defensible appeal letters according to process instructions and guidelines.

The position offers Telecommuting within the U.S., Monday–Friday schedule, and a salary range from $60,200 to $107,400 annually based on full-time employment.

Qualifications

• Associate's degree required
• Unrestricted RN license in your state of residence
• 3+ years bedside nursing in ED/telemetry/ICU/CCU
• Proficiency with Microsoft applications and software, internet navigation

Responsibilities

• Follows directive to compose appeal letters with data extraction and references
• Adheres to HIPAA confidentiality requirements
• Support and promote OPAS, Optum, and enterprise goals
• Build relationships across Optum, OPAS, OGA and clients
• Collaborate with peers to ensure communication and deliverables
• Maintain quality and productivity expectations
• Participate in meetings and contribute as appropriate
• Stay up to date with learning modules and licenses
• Perform related duties as assigned by leadership

Skills

Nursing

HIPAA compliance

Verbal and written communication

Typing 45 wpm

Education

Associate's degree in Nursing (ADN)

Tools

InterQual

MCG

Microsoft Word

Job description

Optum is a global healthcare organization empowering care through technology. The Utilization Management Nurse role involves reviewing medical records, extracting case details, and crafting defensible appeal letters according to process instructions and guidelines.

The position offers Telecommuting within the U.S., Monday–Friday schedule, and a salary range from $60,200 to $107,400 annually based on full-time employment.