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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 month ago
✨ 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
Remote RN Utilization Management Review Nurse - Remote Eligible
SeattleRemote
$58,300 - 114,300 USD / year
Registered Nurse
About Optum
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