USRN with Utilization Review Experience

ROLE AND

RESPONSIBILITIES

Leads and supports clinical content development projects from planning through release, including project tracking, scope management, and stakeholder coordination. Collaborates with Clinical Leadership, physician researchers, Clinical Managers, and Medical Directors to ensure content accuracy, compliance, consistency, and timely delivery. Conducts in-depth medical literature reviews, evaluates and summarizes clinical evidence, and develops comprehensive e-learning materials for physician and nursing audiences. Develops specialized appeals arguments related to patient status, DRG validation, and Clinical Documentation Improvement (CDI) requirements using medical evidence and payer-specific outcomes. Applies risk factor logic, decision-making frameworks, and SQL-based validation to ensure content quality, consistency, and alignment across Optum Clinical Groups and Inter

Qual products. Analyzes medical claims and denials data, identifies trends, categorizes cases, develops analytical frameworks, and recommends content revisions based on data-driven insights. Reviews complex medical records, supports AI-assisted clinical research workflows, provides ad hoc analytics and case reviews, and confidently defends

Your role is critical in allowing our members, families, facilities and health professionals to have greater confidence in the exceptional care we provide. And for you, an everyday opportunity to do your life’s best work.SM.JOB

QUALIFICATIONS

Minimum of 10 years of clinical nursing experience as a practicing nurse, demonstrating extensive hands-on patient care expertise in a hospital settings. At least 2 years of Utilization Review experience, preferably with Physician Advisor Services or a similar Utilization Review organization. Strong knowledge of case management, commercial insurance, Managed Medicare, Traditional Medicare processes, and patient status requirements. Experience with Clinical Documentation Improvement (CDI) requirements to support DRG validation and research initiatives. Minimum of 2 years of clinical content development experience or equivalent experience in healthcare content creation and review. Preferred experience in Electronic Medical Records (EMR) systems. Excellent communication, presentation, research, writing, project management, and computer skills, with the ability to apply decision-tree logic in content development and clinical decision-making.

WHAT WE OFFER

Market Total Rewards Package

Retirement Plan

• Medical Plan (HMO) from Day 1 of employment
• Dental, Medical, and Optical Reimbursements

Life and Disability Insurance

Paid Time-Off

Benefits

Sick Leave Conversion

Tuition Fee Reimbursement

Employee Assistance Program (EAP)Annual Performance Based Merit Increases

Employee Recognition

Training and Staff Development

Employee Referral Program

Employee Volunteerism Opportunity

All Mandatory Statutory

Benefits

• WHO WE AREOptum is the health care technology and innovation company of the United
• Health Group enterprise along with United

Healthcare. United

Health Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone. We’re a leading health solution and care delivery organization. Our work is complex, but our mission is simple: create a healthier world, with you at the center. As part of a Fortune 5 enterprise, we are improving the health care experience of over 125 million people around the world. Elevate your career with a leading health care company while improving lives. Join us in evolving health care so everyone can have the opportunity to live their healthiest life. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together