Per Diem Utilization Management Registered Nurse
About The Position
The Utilization Management Nurse reviews patient medical records, extracts relevant case details, and prepares well-supported appeal letters according to process instructions and department and company guidance. The nurse is expected to complete cases within established time expectations while maintaining high-quality reviews and following Optum and OPAS policies and procedures. This is a per diem role with flexible start times. The position may be performed remotely from anywhere within the United States, subject to UnitedHealth Group’s Telecommuter Policy. The role requires an unrestricted Registered Nurse license in the nurse’s state of residence and at least three years of bedside nursing experience in an ED, telemetry, ICU, or CCU setting.
Requirements
- Associate’s degree.
- Unrestricted Registered Nurse license in the state of residence.
- At least 3 years of bedside nursing experience in ED, telemetry, ICU, or CCU.
- Advanced proficiency with Microsoft applications and software, internet navigation, and utilization.
- Ability to type 45 words per minute.
- Ability to establish priorities, stay self-motivated, work independently, and follow instructions within supervision and structure.
- Positive attitude and ability to function as a collaborative team member.
Nice To Haves
- Working knowledge of Word.
- Effective communication skills.
- Excellent typing skills, with a minimum speed of 45 words per minute.
- Solid, effective verbal and written communication skills.
Responsibilities
- Extract appropriate data from patient medical records and compose well-written appeal letters with proper grammar.
- Use appeal tools, including pre-constructed templates, and include appropriate medical literature references and national criteria guidelines.
- Follow applicable company policies, procedures, and laws.
- Understand and comply with 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.
- Participate in and contribute to meetings as appropriate.
- Maintain organization on the team and promote professional conduct.
- Keep learning modules, competencies, and state-required licenses up to date.
- Perform other related duties, tasks, and processes as required by leadership.
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
Education Level
Associate degree
