ZipRecruiter

Log In

2

Remote Optum Rn Jobs in Oregon (NOW HIRING)

firsthand Health

Remote Triage Nurse

Eugene, OR · Remote

The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support to firsthand individuals and staff, while also supporting outpatient care coordination. This is ...

Curana Health, Inc.

RN Clinical Quality Coordinator

Summary The Quality Registered Nurse (RN) is responsible for overseeing clinical quality, clinic ... Primarily remote or hybrid, with periodic travel to clinic sites as needed * Collaborative, fast ...

firsthand Health

Remote Triage Nurse

Eugene, OR · On-site +1

$80K/yr

The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support to firsthand individuals and staff, while also supporting outpatient care coordination. This is ...

next page

Showing results 1-20

All JobsRemote Optum Rn JobsRemote Optum Rn Jobs in Oregon

Remote Optum Rn information

What is the difference between Remote Optum Rn vs Remote UnitedHealth Group Rn?

AspectRemote Optum RnRemote UnitedHealth Group Rn
CredentialsRegistered Nurse (RN) license, applicable certificationsRegistered Nurse (RN) license, applicable certifications
Work EnvironmentRemote healthcare services, telehealth platformsRemote healthcare services, telehealth platforms
Employer & IndustryOptum, healthcare and health services industryUnitedHealth Group, healthcare and insurance industry

Both Remote Optum Rn and Remote UnitedHealth Group Rn roles involve providing remote nursing care within the healthcare industry. They require similar credentials and work environments, often utilizing telehealth platforms. The main difference lies in the employer and specific focus areas within the healthcare sector, with Optum focusing on health services and UnitedHealth Group encompassing broader health insurance and services.

What are the most commonly searched types of Optum Rn jobs in Oregon? The most popular types of Optum Rn jobs in Oregon are:
What are popular job titles related to Remote Optum Rn jobs in Oregon? For Remote Optum Rn jobs in Oregon, the most frequently searched job titles are:
What job categories do people searching Remote Optum Rn jobs in Oregon look for? The top searched job categories for Remote Optum Rn jobs in Oregon are:
What cities in Oregon are hiring for Remote Optum Rn jobs? Cities in Oregon with the most Remote Optum Rn job openings:
Remote Optum Rn jobs near you

Remote RN - Medical Claims Reviewer

Broadway Ventures

OR • Remote

Other

Posted 9 days ago

Job description

Job Type: Full-time (40 hours/week)
Schedule: Monday-Friday, 8:00 AM - 5:00 PM

Max Salary: W-2 ($65,000/$31.25)

Location: Remote (U.S. - Work from home)
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.

About the Role

We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.

Key Responsibilities
  • Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
  • Assess payment determinations using clinical information and established guidelines.
  • Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
  • Provide clear, well-documented rationales for service approvals or denials.
  • Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
  • Support quality control activities to meet corporate and team objectives.
  • Provide guidance to LPN team members and support non-clinical staff through training and discussions.
  • Assist with special projects and additional responsibilities as assigned.
Minimum QualificationsLicensure:
  • Active, unrestricted RN license in the U.S. and in the state of hire
    OR
  • Active compact multistate RN license (as defined by the Nurse Licensure Compact).
Education:
  • Associate Degree in Nursing
    OR
  • Graduate of an accredited School of Nursing.
Experience:
  • Two years of clinical experience plus at least two years in one of the following:
    • Home Health
    • Utilization/Medical Review
    • Quality Assurance
Skills & Competencies:
  • Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
  • Ability to interpret and apply medical review criteria and clinical guidelines.
  • Proficiency in Microsoft Office and word processing software.
  • Strong analytical, organizational, and decision-making skills.
  • Ability to work independently while managing priorities effectively.
  • Excellent customer service, communication, and critical thinking skills.
  • Ability to handle confidential information with discretion.
Preferred Qualifications
  • Three years of clinical nursing experience in Home Health, Utilization Review, Medical Review, or Quality Assurance (strongly preferred).
  • Proficiency in using multiple screens and software programs simultaneously.

If you are a detail-oriented RN with a passion for medical review, we encourage you to apply!

Apply