UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Utilization Management RN & Coding Specialist
Location
United States
Posted
29 days ago
Salary
$60.2K - $107.4K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Utilization Management RN & Coding Specialist
UnitedHealth Group
Role Description The Utilization Management RN Coder 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. They will educate clients on correct coding and compliance for best practices. They will participate in ALJ (Administrative Law Judge) hearings as representatives of the clients during tele-hearings. The Coding Quality Analyst will complete their case within the time expectations while providing high-quality reviews. The Appeals nurse will perform their job functions, adhering to both Optum and OPAS policies and procedures. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - 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 speed of 45/min - Adheres to company policies and procedures as well as policies, procedures and laws - Understands and comply 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 Qualifications - Associate’s Degree (or higher) - Possess one of the following Coding Certifications: CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDIP, CCDS - Unrestricted RN license required in state of residence - 3+ years of experience in ED, Telemetry, CCU - 1+ years of Inpatient Coding experience Requirements - Pre-authorization experience - Utilization Management experience - Case Management experience - Knowledge of Milliman Criteria - Certified Case Manager (CCM) Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) 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.
Related Guides
Related Categories
Related Job Pages
More Billing Specialist Jobs
Role Description Moore Haven Yacht Club is seeking a highly motivated Reservations & Booking Specialist to join our hospitality team. This full-time remote opportunity allows you to support clients with reservation coordination, booking management, and service assistance from the comfort of your home in Florida. In this role, you will be responsible for delivering a seamless and professional booking experience by: - Managing incoming reservation and booking requests through phone, email, and chat - Accurately processing, confirming, and updating reservations in a timely manner - Providing clients with clear and professional information regarding availability, pricing, and services - Handling modifications, cancellations, and special requests with attention to detail - Ensuring all reservation records are accurately maintained and updated - Collaborating with internal teams to ensure smooth and efficient booking operations - Identifying and escalating priority or complex issues when necessary - Maintaining high standards of professionalism and customer service at all times - Participating in training sessions and ongoing performance development Qualifications - High school diploma or equivalent required - Strong communication skills, both verbal and written - Ability to work independently in a structured remote environment - Proficiency with computers and reservation or customer management systems - Excellent attention to detail and organizational skills - Strong problem-solving ability and customer-first mindset - Ability to manage time effectively and meet service expectations - Previous experience in hospitality, reservations, or customer service is an advantage but not required Benefits We offer a competitive hourly compensation ranging from $17.00 to $28.00 per hour, along with a supportive remote work environment and opportunities for career growth within the hospitality industry.
Scheduling & Reservations Specialist
Traveling with MchailaApplicants must be citizens of the United States, United Kingdom, Australia, Spain, Mexico, or LATAM regions.
Role Description We are seeking a detail-oriented and organized Scheduling & Reservations Specialist to support client bookings, manage scheduling workflows, and ensure a seamless coordination process from start to finish. This is a fully remote opportunity ideal for individuals who enjoy working independently, staying organized, and handling logistics with accuracy. In this role, you will utilize company-provided systems, tools, and training to assist with coordinating reservations, organizing client details, and maintaining efficient workflows. - Coordinate and manage scheduling and reservation requests - Organize booking details including timelines, confirmations, and updates - Communicate with clients to gather necessary information and provide status updates - Maintain accurate records using internal systems and tools - Ensure all scheduling and booking processes are handled efficiently and professionally - Support overall workflow coordination and task management Qualifications - Strong organizational and time management skills - High attention to detail and accuracy - Excellent written and verbal communication skills - Self-motivated and comfortable working independently - Ability to learn new systems and follow structured processes - No prior experience required (training provided) Benefits - Fully remote, flexible work environment - Ongoing training and structured support - Performance-based income potential - Opportunities for advancement and growth - Access to tools and resources to support your success
Booking & Scheduling Specialist
Traveling with MchailaApplicants must be citizens of the United States, United Kingdom, Australia, Spain, Mexico, or LATAM regions.
Role Description We are currently seeking motivated and detail-oriented individuals to join our team as Remote Booking & Scheduling Coordinators. In this role, you will support clients by coordinating appointments, managing reservations, and ensuring all details are handled accurately from start to finish. This fully remote position is ideal for someone who enjoys working behind the scenes, staying organized, and communicating clearly while managing multiple tasks. You'll play a key role in keeping schedules on track and ensuring a smooth, well-coordinated experience for clients. Training and ongoing support are provided, but success in this role requires strong time management, independence, and attention to detail. - Coordinate bookings, schedules, and confirmations - Communicate with clients to gather information and provide updates - Review and track details to ensure accuracy and timely completion - Follow up on outstanding items to keep everything on schedule - Provide professional and friendly support throughout the process Qualifications - Strong organizational and communication skills - Ability to manage multiple tasks and prioritize effectively - Comfortable working independently in a remote environment - Detail-oriented, dependable, and consistent with follow-through - Comfortable using digital tools and online systems - Customer service or administrative experience is a plus, but not required Requirements - Must be 18 years or older - Must have access to a computer and reliable internet - Must be authorized to work in the US, Mexico, Australia, Spain, or LATAM regions Benefits - 100% remote, work-from-home flexibility - Flexible scheduling options - Structured onboarding and guided training - Ongoing support and access to team resources - Opportunity for growth within a collaborative team environment Company Description If you enjoy organizing details, supporting clients, and working in a flexible remote environment, this role offers a great opportunity to build valuable skills while being part of a supportive and growing team.
Transportation Routing Support Specialist
Optimal Dispatch Service LLCThis is an entry-level opportunity with training provided for qualified applicants. Compensation, scheduling, and employment details may vary based on operational needs and applicant qualifications. Applicants acknowledge that representatives associated with employment opportunities may contact them by phone call, text message, or email regarding available positions and application updates.
Role Description Provides routing support and shipment coordination across active freight operations. Helps maintain accurate movement schedules while supporting dispatch workflow consistency. Responsibilities - Monitor route progress and delivery timing - Update shipment milestones in internal systems - Coordinate routing changes when needed - Maintain accurate dispatch logs - Communicate service exceptions promptly - Support freight movement planning - Assist with operational follow-up tasks Qualifications - Clear communication skills - Basic software navigation ability - Organized and dependable work style - Strong accuracy with records - Able to prioritize multiple tasks - Experience is optional Work Environment Task-driven logistics workflow requiring communication, organization, and shipment status management. Communication Notice By applying, you agree to receive employment-related communications through phone, email, or text. These messages may include updates, scheduling, or hiring progress. Text messages may be stopped anytime.