Top 171 Optum Jobs in Pennsylvania

Utilization Management & Clinical Validation RN
Optum —Newtown Square, PA
- $60,200 - $107,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Word processing
7d
Director, Clinical Documentation Integrity - Remote
Optum —Exton, PA
- $112,700 - $193,200 a year
- Full-time
- Remote
- Medicine
- RN License
- Pass drug screening
Telephonic Nurse Practitioner (Per Diem Weekends) - Pennsylvania License Required
Optum —Pittsburgh, PA
- $53 - $79 an hour
- 8 hour shift
- Remote
- Nursing
- Customer service
- Urgent Care
- Paid holidays
Quick Apply
12d
Orthopedic Surgery, Medical Director - Work from home!
Optum —Philadelphia, PA
- $248,000 - $373,000 a year
- 8 hour shift
- Remote
- Medicine
- Surgery
- 5 years
- Health insurance
- 401(k)
Quick Apply
8d
Registered Nurse - Field Assessor - Allentown, PA
Optum —Allentown, PA
- $64,100 - $141,500 a year
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
Coding Quality Analyst
Optum —Newtown Square, PA
- $23.89 - $42.69 an hour
- Full-time
- Remote
- RN License
- Computer literacy
- Pass drug screening
Licensed Behavioral Therapist
Optum —Ambler, PA
- $28.94 - $51.63 an hour
- Full-time
- LMFT
- Microsoft Outlook
- Pass drug screening
- Continuing education credits
- Health insurance
Quick Apply
8d
RN, Patient Care Manager- Home Health
Optum —Camp Hill, PA
- $85,196 - $127,794 a year
- Full-time
- CPR Certification
- Management
- RN License
- Health insurance
Quick Apply
7d
Registered Nurse - RN
Optum —Hollsopple, PA
- $64,100 - $141,500 a year
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
RN, Home Health
Optum —Hazleton, PA
- $41.35 - $62.03 an hour
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
Licensed Behavioral Clinician
Optum —Pittsburgh, PA
- $59,500 - $116,600 a year
- Full-time
- LMFT
- Microsoft Outlook
- Addiction Medicine
- Health insurance
- Tuition reimbursement
Quick Apply
8d
Nurse Practitioner, Northampton Monroe Counties
Optum —Allentown, PA
- $109,500 - $164,000 a year
- Full-time
- Vital signs
- Pass drug screening
- Mid-level
- Loan repayment program
Quick Apply
Licensed Behavioral Clinician
Optum —Philadelphia, PA
- $28.94 - $51.63 an hour
- Full-time
- Hybrid work
- LMFT
- Microsoft Outlook
- Addiction Medicine
- Health insurance
- Tuition reimbursement
Quick Apply
8d
Part Time UM Medical Director - Plastic Surgeon - Remote anywhere in US
Optum —Philadelphia, PA
- $248,500 - $373,000 a year
- Weekends as needed
- Remote
- Surgery
- 5 years
- Pass drug screening
- Work from home
Quick Apply
RN Home Health Weekends
Optum —Harrisburg, PA
- $70,832 - $106,248 a year
- Full-time
- CPR Certification
- RN License
- Pass drug screening
Quick Apply
7d
Patient Care Manager - Geisinger Hospice-Selinsgrove
Optum —Selinsgrove, PA
- $82,004 - $123,006 a year
- Full-time
- CPR Certification
- Management
- RN License
Quick Apply
1d
Licensed Behavioral Healthcare
Optum —North Wales, PA
- $28.94 - $51.63 an hour
- Full-time
- LMFT
- Microsoft Outlook
- Pass drug screening
- Continuing education credits
- Health insurance
Quick Apply
8d
Home Health Registered Nurse
Optum —Bloomsburg, PA
- $41.35 - $62.03 an hour
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
8d
Patient Care Manager - RN
Optum —Pottstown, PA
- $94,164 - $141,246 a year
- Full-time
- CPR Certification
- Management
- RN License
- Health insurance
Quick Apply
Nurse Practitioner - HouseCalls - Dual Statewide Traveler - MD & PA
Optum —Philadelphia, PA
- $109,500 - $164,000 a year
- Full-time
- Vital signs
- Pass drug screening
- Mid-level
- Loan repayment program
Quick Apply
12d

I want to receive the latest job alert for optum in pennsylvania

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

optum jobs near pennsylvania

Registered Nurse Home Health jobs in Harrisburg, PA

Behavioral Health Counselor jobs in Philadelphia, PA

Registered Nurse jobs in Pottstown, PA

Nurse Practitioner jobs in Philadelphia, PA

Plastic Surgeon jobs in Philadelphia, PA

Nurse Practitioner jobs in Pittsburgh, PA

Nurse Practitioner jobs in Allentown, PA

Registered Nurse jobs in Midland, MI

Electronic Health Records jobs in North Carolina

Banner Health jobs in Sun City, AZ

Vaccination Nurse jobs in Minnesota

Nurse Practitioner Part Time jobs in Phoenix, AZ

Nurse Assessor jobs in San Francisco, CA

Nurse Assessor jobs in Burlington, NJ

Nurse Assessor jobs in Louisville, KY

Nurse Assessor jobs in North Carolina

Logistics Manager jobs in New Jersey

Patient Care Tech jobs in Houston, TX

Wound Care Nurse Practitioner jobs in Chicago, IL

Hospice Care Manager jobs in Aurora, IL

Utilization Management & Clinical Validation RN

Optum -
Newtown Square, PA

Apply Now

Job Details

Full-time
$60,200 - $107,400 a year
7 days ago

Qualifications

Appeals
RN License
Case appeal in utilization management
Insurance claims appeal handling

Full 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 to start Caring. Connecting. Growing together.

The Utilization Management & Clinical Validation RN 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. They will have a working knowledge encoder use and selecting appropriate, supportable appeal arguments from evidence-based, peer reviewed medical literature as provided as well as interpreting and utilizing ICD 9 and 10, CM and PCS, CPT coding system, and HCPCS guidelines. They will recommend changes to coding which will retain, lessen, or increase financial impact when analysis of chart indicates opportunities. The Appeals nurse will perform their job functions, adhering to both Optum and OPAS policies and procedures, which include but are not limited to the following:

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Adheres to approved schedule and arrives to work timely
Maintains accurate accounts of time off in both Verint and HR Direct as per guidelines, and follows directives for time off, schedule changes, etc.
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, and inclusion of appropriate medical literature references
Use and fluency of encoders, coding clinics, ICD-9 and 10 guidelines, CM and PCS, CPT coding system and HCPCS guidelines
Working knowledge of Word
Effective communication skills
Excellent typing skills with a minimum of 45/min speed
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 directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Associates degree or higher
Unrestricted RN license required in state of residence
3+ years of Clinical experience in ED/Telemetry/Critical Care
2+ years of experience in clinical validation appeals

Preferred Qualifications:

Pre-authorization experience
License certified coder
Utilization Management experience
Case Management experience
Knowledge of Milliman Criteria
Certified Case Manager (CCM)
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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 $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO, #GREEN

Apply Now

Refine Your Search

optum jobs in pennsylvania

Utilization Management & Clinical Validation RN

Director, Clinical Documentation Integrity - Remote

Telephonic Nurse Practitioner (Per Diem Weekends) - Pennsylvania License Required

Orthopedic Surgery, Medical Director - Work from home!

Registered Nurse - Field Assessor - Allentown, PA

Coding Quality Analyst

Licensed Behavioral Therapist

RN, Patient Care Manager- Home Health

Registered Nurse - RN

RN, Home Health

Licensed Behavioral Clinician

Nurse Practitioner, Northampton Monroe Counties

Licensed Behavioral Clinician

Part Time UM Medical Director - Plastic Surgeon - Remote anywhere in US

RN Home Health Weekends

Patient Care Manager - Geisinger Hospice-Selinsgrove

Licensed Behavioral Healthcare

Home Health Registered Nurse

Patient Care Manager - RN

Nurse Practitioner - HouseCalls - Dual Statewide Traveler - MD & PA

I want to receive the latest job alert for optum in pennsylvania

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected