Utilization Management Nurse RN
About The Position
The Utilization Management Nurse reviews patient medical records, extracts pertinent case details, and prepares defensible appeal letters in accordance with process instructions and department and company guidance. The role is responsible for completing reviews within expected timeframes while maintaining quality and adhering to Optum and OPAS policies and procedures. The position is scheduled Monday through Friday for 40 hours per week, with flexible start times and the ability to support evening, weekend, and holiday shifts. Telecommuting is available from anywhere in the United States, subject to UnitedHealth Group’s Telecommuter Policy.
Requirements
- Associate’s degree.
- Unrestricted Registered Nurse license in the state of residence.
- At least 3 years of bedside nursing experience in adult ED, telemetry, ICU, or CCU.
- Advanced proficiency with Microsoft applications and software, internet navigation, and utilization.
- Ability to type 45 words per minute.
Nice To Haves
- Working knowledge of InterQual and MCG.
- Prior utilization management experience.
- Working knowledge of Word.
- Strong, effective verbal and written communication skills.
Responsibilities
- Review patient medical records and extract relevant case details.
- Construct appeal letters using appropriate data extraction, templates and appeal tools, sound grammar, relevant medical literature references, and national criteria guidelines.
- Adhere to company policies and procedures, applicable laws, and HIPAA confidentiality requirements.
- Support and promote OPAS, Optum, and enterprise goals and mission.
- Build relationships across Optum, OPAS, OGA, and clients.
- Collaborate with peers to support continuity of communication and execution of deliverables.
- Meet quality and productivity expectations and complete cases within expected timeframes.
- Participate in and contribute to meetings as appropriate.
- Help maintain team organization and professional conduct.
- Keep learning modules, competencies, and state-required licenses current.
- Perform other related duties, tasks, and processes as required by leadership.
- Establish priorities, work independently, follow instructions, and contribute collaboratively as a team member.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 401(k) contribution, subject to eligibility requirements.
- Career development opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
