Utilization Management Nurse RN — Appeals & Care Coordination

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

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.