Utilization Management Nurse RN - National Remote

Lensa; United States; Remote; USD 58,000 - 105,000; Full time

Job summary

A leading healthcare organization seeks a Utilization Management Nurse RN to review patient medical records and craft strong appeal letters. This full-time role offers flexibility to telecommute from anywhere in the U.S. Candidates will need a Registered Nurse license and at least three years of relevant experience. Enjoy comprehensive benefits and opportunities for career development while making a significant impact in healthcare.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Qualifications

• Active and unrestricted Registered Nurse license in state of residence.
• 3+ years of bedside nursing experience in ED/telemetry/ICU/CCU.
• Advanced level of proficiency with Microsoft applications.

Responsibilities

• Review and extract case details from medical records.
• Compose defensible appeal letters.
• Comply with HIPAA confidentiality requirements.

Skills

Communication

Teamwork

Data extraction

Attention to detail

Education

Associates degree or higher

Tools

Microsoft applications

Job description

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Pay found in job post

Retrieved from the description.

Base pay range

$58,800.00/yr - $105,000.00/yr

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for UnitedHealth Group.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Utilization Management Nurse RN will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department’s/company’s guidance. The nurse will complete their case within the time expectations while providing high quality reviews. The Utilization Management Nurse will perform their job functions, adhering to both Optum and OPAS policies and procedures, which include but are not limited to the following

Schedule: M-F (40 Hours a Week) Flexible start times with the ability to support evening, weekend and holiday shifts.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Follows directive of composing appeal letters to include appropriate data extraction, construction of well-written appeals letters with proper grammar, utilization of appeal tools including pre-constructed templates, inclusion of appropriate medical literature references, and use of national criteria guidelines. Adheres to company policies and procedures as well as policies, procedures, and laws
• Understands and complies with HIPAA confidentiality requirements
• Support and promote OPAS, Optum, and the enterprise goals and mission
• Build relationships across Optum, OPAS, OGA and our clients
• Collaborate with peers to assure continuity of communication and execution of deliverables as needed
• Adheres to quality and productivity expectations
• Participate in and contribute to meetings as appropriate
• Maintains organization on the team and ensures everyone conducts themselves professionally
• Remains up to date with all learning modules, competencies, and state required licenses
• Performs other related duties, tasks, and processes as required by leadership
• Ability to establish priorities, be self-motivated, work independently, and follow instructions with supervision and structure
• Positive attitude and the ability to function as a collaborative team member
  
  

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Associates degree (or higher)
• Active and unrestricted Registered Nurse license in your state of residence
• 3+ years of bedside nursing experience in ED/telemetry/ICU/CCU
• Advanced level of proficiency with Microsoft applications and software, internet navigation and utilization
• Ability to type 45WPM
  
  

Preferred Qualifications

• Working knowledge of Word
• Effective communication skills
• Excellent typing skills with a minimum of 45/min speed
• Strong, effective verbal and written communication skills
• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
  
  

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN

If you have questions about this posting, please contact [e-mail]

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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