Utilization Management Nurse RN

UnitedHealth Group • Newtown Square, PA

77d • $58,800 - $105,000 • Remote

About The Position

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.

Requirements

• Associate's 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.

Nice To Haves

• Working knowledge of Word.
• Effective communication skills.
• Excellent typing skills with a minimum speed of 45 words/minute.
• Strong, effective verbal and written communication skills.

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.
• 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 ensure 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.

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.
• 401(k) Savings Plan, Employee Stock Purchase Plan.
• Education Reimbursement.
• Employee Discounts.
• Employee Assistance Program.
• Employee Referral Bonus Program.
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree