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Remote RN Utilization Management Review Nurse - Remote Eligible

Ensure compliance with HIPAA standards for protected health information.
SeattleRemote
Mid-Level
$58,300 - 114,300 USD / year
1 week ago
Optum

Optum

We’re a leading health solution and care delivery organization

✨ About The Role

- Responsible for ensuring the integrity of adverse determination processes and accuracy of clinical decision making - Composes denial letters in compliance with federal regulations, state regulations, health plan requirements, and NCQA standards - Collaborates with medical directors on cases that do not meet established guidelines for compliant denial notices - Conducts quality assurance audits on each denial to ensure compliance with established guidelines - Identifies gaps in training or processes impacting the overall compliance of adverse determinations and communicates effective performance improvement solutions

⚑ Requirements

- Experienced Registered Nurse with at least 3 years of care management, utilization review, or discharge planning experience - Strong understanding of health care criteria and protocols, with the ability to ensure accuracy and compliance in adverse determination processes - Detail-oriented individual who can construct denial notices in compliance with federal regulations, state regulations, and health plan requirements - Excellent communication skills to effectively collaborate with team members, medical directors, and requesting providers - Ability to work independently and remotely, while maintaining productivity targets and adhering to HIPAA standards
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Remote RN Utilization Management Review Nurse - Remote Eligible
SeattleRemote
$58,300 - 114,300 USD / year
Registered Nurse
About Optum
We’re a leading health solution and care delivery organization