Inpatient Nurse Informaticist

UnitedHealth Group•Eden Prairie, MN

4h•$72,800 - $130,000

About The Position

The Inpatient Nurse Informaticist / Clinical Annotation Specialist is a clinical subject matter expert supporting the development, validation, and ongoing optimization of AI-driven inpatient utilization management and concurrent review models. The role reviews medical records, performs annotation activities, validates clinical criteria, and supports quality assurance to help ensure models reflect evidence-based medical necessity, utilization management standards, and regulatory requirements. Working with Nurse Informaticist Leads and Data Science, Product, Technology, and Clinical Operations teams, the position contributes to clinically sound, scalable AI solutions for inpatient admission, concurrent review, and length-of-stay determinations. It also provides clinical insight, supports model development and testing, participates in implementation and process improvement, and helps ensure compliance with organizational and regulatory standards and secure handling of protected health information.

Requirements

Registered Nurse (RN) with an active, unrestricted license.
At least 3 years of clinical nursing experience, including inpatient acute care, utilization management, case management, or medical necessity review.
At least 2 years of utilization management, clinical documentation review, or nursing informatics experience.
Experience working within a health plan or managed care organization.
Experience reviewing inpatient medical records and applying medical necessity criteria.
Experience working with interdisciplinary clinical teams.
Knowledge of InterQual, MCG, or other utilization management criteria.
Knowledge of utilization management principles and medical necessity criteria.
Solid understanding of inpatient admission and concurrent review processes.
Familiarity with clinical documentation standards and electronic health records.
Proficiency with clinical systems, data review tools, and Microsoft Office applications.
Proven solid analytical and critical-thinking skills.
Proven excellent written and verbal communication skills.
Proven ability to work independently while managing multiple priorities.

Nice To Haves

At least 2 years of acute care inpatient nursing experience.
Experience supporting AI/ML model development, clinical data annotation, or healthcare analytics initiatives.
Experience performing Prior Authorization reviews within a health plan, managed care, or utilization management environment, including applying medical necessity criteria and evidence-based clinical guidelines.

Responsibilities

Perform detailed clinical annotation of inpatient medical records using established guidelines and utilization management criteria.
Review and classify clinical documentation for AI model training and validation.
Ensure annotation accuracy, consistency, and compliance with established standards.
Identify documentation patterns, trends, and opportunities to improve annotation processes.
Conduct quality reviews of annotated records for data integrity and clinical accuracy.
Help validate AI model outputs against established clinical criteria.
Escalate complex or ambiguous cases to clinical leadership.
Support monitoring of model performance and quality metrics.
Contribute to the development and refinement of annotation guidelines and workflows.
Serve as a clinical resource for data science and technology teams.
Provide clinical insights on inpatient utilization management workflows and medical necessity requirements.
Assist with model development and testing.
Support implementation of concurrent review and length-of-stay initiatives.
Collaborate with clinical operations, nursing, physician advisors, product, and technology partners.
Participate in cross-functional meetings and provide clinical expertise and feedback.
Support training and onboarding of new annotation team members.
Contribute to process improvement initiatives that enhance efficiency and quality.
Maintain compliance with organizational, CMS, NCQA, and regulatory standards.
Handle protected health information appropriately and securely.
Apply evidence-based guidelines and utilization management criteria consistently.
Support audit and governance activities as needed.