Utilization Management Nurse RN

UnitedHealth Group; Pennsylvania; On-site; USD 60,000 - 107,000; Full time

Job summary

UnitedHealth Group is seeking a Utilization Management Nurse to review patient medical records, extract essential case details, and craft defensible appeal letters in a structured, quality-focused environment.

This full-time role in Newtown Square, PA requires RN licensure and 3+ years of bedside nursing in acute care, with strong data extraction, HIPAA compliance, and MS Office skills to support appeals and enterprise goals.

Qualifications

• Associate degree in nursing required.
• 3+ years bedside nursing in adult ED/telemetry/ICU/CCU.
• Unrestricted RN license in your state of residence.

Responsibilities

• Compose appeal letters with data extraction and grammar.
• Use appeal tools including templates and medical literature references.
• Comply with HIPAA confidentiality requirements.
• Support and promote OPAS, Optum, and enterprise goals.
• Build relationships across Optum, OPAS, OGA, and clients.
• Collaborate with peers to ensure continuity of communication.
• Adhere to quality and productivity expectations.
• Participate in and contribute to meetings as appropriate.
• Maintain organization on the team and ensure professionalism.

Skills

Nursing experience

HIPAA compliance

Data extraction

Strong communication

Education

Associate's degree

Tools

Microsoft Office

Job description

About This Role

The Utilization Management Nurse will accurately review and extract pertinent case details from patient medical records and craft defensible appeal letters. This role is ideal for those who thrive in a structured environment and are committed to high-quality patient care.

Highlights

• Pay: $60,200 - $107,400/year


• Location: Newtown Square, PA


• Schedule: Full Time, Monday - Friday (40 Hours a Week), Flexible start times

What You'll Do

• Compose appeal letters with appropriate data extraction and proper grammar


• Utilize appeal tools including pre-constructed templates and medical literature references


• Comply with HIPAA confidentiality requirements


• Support and promote OPAS, Optum, and enterprise goals


• Build relationships across Optum, OPAS, OGA, and clients


• Collaborate with peers to ensure continuity of communication


• Adhere to quality and productivity expectations


• Participate in and contribute to meetings as appropriate


• Maintain organization on the team and ensure professionalism


• Remain up to date with learning modules, competencies, and state required licenses

Requirements

Education:

• Associate's degree required

Experience:

• 3+ years of bedside nursing experience in adult ED/telemetry/ICU/CCU

Licenses & Certifications:

• Unrestricted Registered Nurse license in your state of residence required


• Advanced proficiency with Microsoft applications required


• Ability to type 45 wpm required

Preferred Qualifications:

• Working knowledge of InterQual and MCG


• Prior experience with utilization management


• Strong verbal and written communication skills

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving health outcomes through innovative solutions and a culture of inclusion and collaboration.