Inpatient Nurse Informaticist

Job description

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together. The Inpatient Nurse Informaticist / Clinical Annotation Specialist serves as a clinical subject matter expert supporting the development, validation, and ongoing optimization of AI-driven inpatient utilization management and concurrent review models. This role applies clinical expertise to review medical records, perform annotation activities, validate clinical criteria, and support quality assurance processes that ensure models accurately reflect evidence-based medical necessity, utilization management standards, and regulatory requirements. Working closely with Nurse Informaticist Leads, Data Science, Product, Technology, and Clinical Operations teams, this position contributes to creating clinically sound, scalable, and high-quality AI solutions that support inpatient admission, concurrent review, and length-of-stay determinations. Primary Responsibilities: • Clinical Annotation & Validation • Perform detailed clinical annotation of inpatient medical records based on established guidelines and utilization management criteria • Review and classify clinical documentation to support AI model training and validation activities • Ensure annotation accuracy, consistency, and adherence to established standards • Identify documentation patterns, trends, and opportunities for annotation process improvement • Clinical Quality Assurance • Conduct quality reviews of annotated records to ensure data integrity and clinical accuracy • Assist in validation of AI model outputs against established clinical criteria • Escalate complex or ambiguous cases to clinical leadership for review and resolution • Support ongoing monitoring of model performance and quality metrics • Contribute to development and refinement of annotation guidelines and workflows • Clinical Informatics Support • Serve as a clinical resource for data science and technology teams • Provide clinical insights regarding inpatient utilization management workflows and medical necessity requirements • Assist with model development and testing • Support implementation of new concurrent review and length-of-stay initiatives • Collaboration & Stakeholder Engagement • Collaborate with clinical operations, nursing, physician advisors, product, and technology partners • Participate in cross-functional meetings to provide clinical expertise and feedback • Support training and onboarding of new annotation team members • Contribute to process improvement initiatives that enhance efficiency and quality • Compliance & Regulatory Support • Maintain compliance with organizational, CMS, NCQA, and regulatory standards • Ensure protected health information (PHI) is handled appropriately and securely • Apply evidence-based guidelines and utilization management criteria consistently • Support audit and governance activities as needed 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.

Responsibilities

Requirements

• • Registered Nurse (RN) with active, unrestricted license • 3+ years of clinical nursing experience, including inpatient acute care, utilization management, case management, or medical necessity review • 2+ years of utilization management, clinical documentation review, or nursing informatics experience • Experience working within a health plan or managed care organization • Experience reviewing inpatient medical records and applying medical necessity criteria • Experience working with interdisciplinary clinical teams • Knowledge of InterQual, MCG, or other utilization management criteria • Knowledge of utilization management principles and medical necessity criteria • Solid understanding of inpatient admission and concurrent review processes • Familiarity with clinical documentation standards and electronic health records • Proficiency with clinical systems, data review tools, and Microsoft Office applications • Proven solid analytical and critical-thinking skills • Proven excellent written and verbal communication skills • Proven ability to work independently while managing multiple priorities • 2+ years of acute care inpatient nursing experience • Experience supporting AI/ML model development, clinical data annotation, or healthcare analytics initiatives • Experience performing Prior Authorization reviews within a health plan, managed care, or utilization management environment, including application of medical necessity criteria and evidence-based clinical guidelines Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives. UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

About UnitedHealth Group / Optum

Optum Home & Community Care is part of UnitedHealth Group and provides telephonic case management services to help members navigate the health care system and access support services. As an RN Case Manager, you would assess members' health status, identify gaps in treatment plans, establish care goals, coordinate with multidisciplinary teams including mental health clinicians, provide patient education and coaching, make referrals to community resources, and facilitate transitions between care settings—primarily through phone calls in a high-volume customer service environment.