Utilization Management Nurse RN

The Utilization Management Nurse 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: Monday - Friday (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

Required Qualifications

• Associate's degree
• 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 45 wpm

Preferred Qualifications

• Working knowledge of InterQual and MCG
• Prior experience with utilization management
• Working knowledge of Word
• Strong, effective verbal and written communication skills

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.