Per Diem Utilization Management Nurse RN - Remote

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

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: Per Diem as needed, flexible start times with the ability to support evening, weekend and holiday shifts. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

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 You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.