Top 18 Utilization review nurse Jobs in Wilmington De

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
Utilization Management & Clinical Validation RN
Optum —Newtown Square, PA
- $60,200 - $107,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Word processing
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
RN Medical Review Nurse (Hybrid)
NFP Corp —Woodbury, NJ
- $77,000 - $94,000 a year
- Full-time
- Nursing
- RN License
- Computer literacy
- Paid holidays
- Paid time off
11d
Utilization Reviewer 2
Enlyte —Wayne, PA
- $52,750 - $76,000 a year
- Full-time
- LVN
- RN License
- Mid-level
- Health savings account
- AD&D insurance
6d
RN Utilization Management - Day Shift
Christiana Care Health Systems —Newark, DE
- $85,862.40 - $137,384.00 a year
- Full-time
- Nursing
- RN License
- Hospital
PRN Clin Resource Coordinator at HUP
Penn Medicine —Philadelphia, PA
- PRN
- Nursing
- Microsoft Outlook
- RN License
- Tuition reimbursement
Quick Apply
Hospice Registered Nurse
Ataam Health Care —Wilmington, DE
- $60 an hour
- Contract
- Nursing
- Vital signs
- RN License
Quick Apply
12d
Nurse Care Manager
Meta Care Inc., —Philadelphia, PA
- From $70,000 a year
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Mileage reimbursement
- Disability insurance
Quick Apply
Registered Nurse Case Manager- Inpatient Units
Children’s Hospital of Philadelphia —Philadelphia, PA
- $101,300 - $129,100 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Quick Apply
Care Manager
GSPP Rehabilitation —Philadelphia, PA
- 8 hour shift
- Nursing
- RN License
- Licensed Clinical Social Worker
Nurse Practitioner / Physician Assistant
Regenerative Health LLC —Springfield, PA
- $30,000 - $75,000 a year
- Part-time
- HIPAA
- Mid-level
- Outpatient experience
- Flexible schedule
- Referral program
Quick Apply

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Based on your search for utilization review nurse

Care Management Nurse
Wellspan Health —Ephrata, PA
Assists with the collection and analysis of utilization patterns and denied cases. Assists the patient care team with the identification and coordination of…
14d
Utilization Management Nurse RN
Optum —Newtown Square, PA
Unrestricted Registered Nurse license in your state of residence. Remains up to date with all learning modules, competencies, and state required licenses.
$60,200 - $107,400 a year
7d

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Case Manager (RN) - Full-Time
OhioHealth Rehabilitation Hospital —Columbus, OH
Current Licensure per state guidelines in clinical or related discipline OR a Bachelor's or Master's in a health or human services discipline.
$70,000 - $84,000 a year
Quick Apply
5d
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…

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Utilization Management Nurse RN

Optum -
Newtown Square, PA

Apply Now

Job Details

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

Qualifications

RN License
Desktop applications
Typing
Associate's degree

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 Nurse 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. The nurse will complete their case within the time expectations while providing high quality reviews. The Utilization Management Nurse will perform their job functions, adhering to both Optum and OPAS policies and procedures, which include but are not limited to the following

Schedule: Monday - Friday (40 Hours a Week) Flexible start times with the ability to support evening, weekend and holiday shifts.

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

Primary Responsibilities:

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, inclusion of appropriate medical literature references, and use of national criteria guidelines. 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 direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Associate's degree
Unrestricted Registered Nurse license in your state of residence
3+ years of bedside nursing experience in adult ED/telemetry/ICU/CCU
Advanced level of proficiency with Microsoft applications and software, internet navigation and utilization
Ability to type 45 wpm

Preferred Qualifications:

Working knowledge of InterQual and MCG
Prior experience with utilization management
Working knowledge of Word
Strong, effective verbal and written communication skills
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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

#RPO #GREEN

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Refine Your Search

utilization review nurse jobs in wilmington de

Utilization Management Nurse RN

Utilization Management & Clinical Validation RN

Utilization Review Nurse

Utilization Management Nurse

RN Medical Review Nurse (Hybrid)

Utilization Reviewer 2

RN Utilization Management - Day Shift

PRN Clin Resource Coordinator at HUP

Hospice Registered Nurse

Nurse Care Manager

Registered Nurse Case Manager- Inpatient Units

Care Manager

Nurse Practitioner / Physician Assistant

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