Top 487 Review nurse Jobs in Wilmington De

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
7d
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 Review Nurse
Penn Medicine —West Chester, PA
- Nursing
- RN License
- Mid-level
- Tuition reimbursement
Quick Apply
14d
Utilization Management Nurse
Children’s Hospital of Philadelphia —Philadelphia, PA
- $92,100 - $117,400 a year
- Full-time
- Nursing
- RN License
- 5 years
Quick Apply
Registered Nurse I-III
State of Delaware —New Castle, DE
- Call employer
- Nursing
- Current TB test
- Psychiatry
- Referral program
Clinical Documentation Improvement Specialist
Thomas Jefferson University and Hospitals —Philadelphia, PA
- Full-time
- Nursing
- Medicine
- Bachelor of Science
- Continuing education credits
- AD&D insurance
Hospital Transition Care Coordinator
Penn Medicine —West Chester, PA
- Nursing
- Certified Nurse Practitioner
- Mid-level
- Tuition reimbursement
Quick Apply
Registered Nurse - Infection Preventionist
Wilmington VA Medical Center —Wilmington, DE
- $81,491 - $146,856 a year
- Full-time
- Nursing
- Doctoral degree
- RN License
- Health savings account
- Paid holidays
Quick Apply
14d
Ambulatory Infection Preventionist RN - Part Time
Penn Medicine —Philadelphia, PA
- Part-time
- Nursing
- RN License
- Bachelor of Science
- Tuition reimbursement
Quick Apply
Licensed Practical Nurse (LPN) Case Management
COMMUNITY INTERACTIONS INC —Wilmington, DE
- Online Application
- Nursing
- Clean driving record
- Writing skills
- COVID-19 protective measures
- 401(k)
Quick Apply
RN Night Supervisor
Cadia Healthcare Pike Creek —Wilmington, DE
- No weekends
- Skilled nursing facility
- RN License
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
6d
Registered Nurse
Melmark —Berwyn, PA
- $40 an hour
- Full-time
- Experience working with individuals with developmental disabilities
- RN License
- Mid-level
- 403(b) matching
- AD&D insurance
Quick Apply
Full-time 3p-11p shift Nurse (RN/LPN)
Cadia Healthcare Broadmeadow —Middletown, DE
- Part-time
- CPR Certification
- Skilled nursing facility
- RN License
- Paid holidays
- Disability insurance
Quick Apply
Registered Nurse (RN)
VITAS Healthcare —Newark, DE
- $38 - $43 an hour
- Weekends as needed
- Nursing
- RN License
- Inpatient
- Disability insurance
- Health insurance
Quick Apply
Neonatal Nurse Practitioner or Physician Assistant
Nemours —Wilmington, DE
- Online Application
- BLS Certification
- Inpatient
- Critical & Intensive Care
- Health insurance
- Dental insurance
Healthcare Coordinator RN
Melmark —Berwyn, PA
- $89,440 a year
- Full-time
- RN License
- Writing skills
- Mid-level
- 403(b) matching
- AD&D insurance
Quick Apply
Nurse Practitioner and/or Physician Assistant
Cardiology Consultants of Philadelphia —Springfield, PA
- Full-time
- Computer literacy
- BLS Certification
- Mid-level
- Profit sharing
- Paid holidays
Quick Apply
Registered Nurse (RN)
Cadia Healthcare Pike Creek —Wilmington, DE
- Part-time
- CPR Certification
- Skilled nursing facility
- RN License
- Paid holidays
- Disability insurance
Quick Apply
RN Evening Supervisor
Elkton Nursing & Rehabilitation Center —Elkton, MD
- $38 - $43 an hour
- Full-time
- Nursing
- RN License
- Customer service
Quick Apply

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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

review nurse jobs in wilmington de

Utilization Management & Clinical Validation RN

Utilization Management Nurse RN

Clinical Appeals Nurse - Full Time Remote - Jefferson Health

Utilization Review Nurse

Utilization Management Nurse

Registered Nurse I-III

Clinical Documentation Improvement Specialist

Hospital Transition Care Coordinator

Registered Nurse - Infection Preventionist

Ambulatory Infection Preventionist RN - Part Time

Licensed Practical Nurse (LPN) Case Management

RN Night Supervisor

Registered Nurse

Full-time 3p-11p shift Nurse (RN/LPN)

Registered Nurse (RN)

Neonatal Nurse Practitioner or Physician Assistant

Healthcare Coordinator RN

Nurse Practitioner and/or Physician Assistant

Registered Nurse (RN)

RN Evening Supervisor

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