Top 102 Clinical documentation & utilization review nurses 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
Utilization Management Nurse RN
Optum —Newtown Square, PA
- $60,200 - $107,400 a year
- Weekends as needed
- Remote
- Nursing
- RN License
- Pass drug screening
4d
Clinical Appeals Nurse - Full Time Remote - Jefferson Health
Thomas Jefferson University and Hospitals —Philadelphia, PA
- Full-time
- Remote
- Microsoft Word
- Nursing
- RN License
- AD&D insurance
- Disability insurance
Utilization Management Nurse Consultant
CVS Health —Pennsylvania
- $29.10 - $62.32 an hour
- Weekends as needed
- Remote
- Google Workspace
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
9d
STS Abstractor
HEALTH INFORMATION ALLIANCE INC —Fort Washington, PA
- Part-time
- Remote
- Nursing
- RN License
- Computer literacy
Utilization Management Registered Nurse
Humana —Pennsylvania
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
AMERICAN SPINE REGISTRY ASR Data Abstractor (PRN)
Health Information Alliance —Fort Washington, PA
- PRN
- Remote
- Nursing
- RN License
- Computer literacy
RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus)
Temple University Health System —Philadelphia, PA
- Weekends as needed
- Hybrid work
- Nursing
- RN License
- Hospital
Clinical Documentation Integrity Specialist I
Wellspan Health —York, PA
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Paid parental leave
- Health insurance
11d
Contract Clinical Auditor
Marsh McLennan Agency —Conshohocken, PA
- $175 a day
- Part-time
- Remote
- RN License
- HIPAA
- Mid-level
Director, Clinical Documentation Integrity - Remote
Optum —Exton, PA
- $112,700 - $193,200 a year
- Full-time
- Remote
- Medicine
- RN License
- Pass drug screening
Utilization Review Nurse
Penn Medicine —West Chester, PA
- Nursing
- RN License
- Mid-level
- Tuition reimbursement
Quick Apply
11d
RNAC
Confidential Posting —Pittsburgh, PA
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
11d
RN REGISTERED NURSE ASSESSMENT COORDINATOR
Elan Skilled Nursing —Scranton, PA
- From $42 an hour
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse Assessment Coordinator
Havencrest Rehabilitation and Healthcare —Monongahela, PA
- Full-time
- Hybrid work
- Skilled nursing facility
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
13h
Regional RAI Specialist (Clinical Reimbursement)
Confidential Healthcare Facility —Harrisburg, PA
- $105,000 - $115,000 a year
- Full-time
- Skilled nursing facility
- RN License
- 5 years
- Travel reimbursement
- Opportunities for advancement
Quick Apply
Regional RAI Specialist (Clinical Reimbursement)
Confidential Healthcare Facility —Lancaster, PA
- $105,000 - $115,000 a year
- Full-time
- Skilled nursing facility
- RN License
- 5 years
- Travel reimbursement
- Opportunities for advancement
Quick Apply
Registered Nurse Assessment Coordinator (RN MDS Coordinator)
Confidential Healthcare Facility —Myerstown, PA
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Commuter assistance
- Disability insurance
Quick Apply
MDS Coordinator (RNAC)
Holy Family Senior Living, Inc. —Bethlehem, PA
- Up to $41 an hour
- Full-time
- RN License
- Mid-level
- In-person
- Paid holidays
- Disability insurance
Quick Apply
R&E Nurse- Med Care Services (RN) - (DHS)
QPCS —Harrisburg, PA
- $43 - $48 an hour
- Full-time
- Background check
- Nursing
- RN License
- Paid holidays
- Health insurance
Quick Apply
14d

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Utilization Management & Clinical Validation RN

Optum -
Newtown Square, PA

Apply Now

Job Details

Full-time
$60,200 - $107,400 a year

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

clinical documentation & utilization review nurses jobs in pennsylvania

Utilization Management & Clinical Validation RN

Utilization Management Nurse RN

Clinical Appeals Nurse - Full Time Remote - Jefferson Health

Utilization Management Nurse Consultant

STS Abstractor

Utilization Management Registered Nurse

AMERICAN SPINE REGISTRY ASR Data Abstractor (PRN)

RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus)

Clinical Documentation Integrity Specialist I

Contract Clinical Auditor

Director, Clinical Documentation Integrity - Remote

Utilization Review Nurse

RNAC

RN REGISTERED NURSE ASSESSMENT COORDINATOR

Registered Nurse Assessment Coordinator

Regional RAI Specialist (Clinical Reimbursement)

Regional RAI Specialist (Clinical Reimbursement)

Registered Nurse Assessment Coordinator (RN MDS Coordinator)

MDS Coordinator (RNAC)

R&E Nurse- Med Care Services (RN) - (DHS)

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