Critical Care Nurse (ICU/ER/CCU) – PHRN – Day 1 HMO

About the role

The Clinical Appeals Nurse at Optum works closely with Physician Advisors to provide defensible and accurate case recommendations for concurrent admissions, continued stays, and denials. This role ensures that members, families, facilities, and health professionals receive confident, high‑quality care.

Key responsibilities

• Review and recommend case actions for concurrent admission, continued stay, and denial cases.
• Collaborate directly with Physician Advisors, following their guidance to ensure accurate recommendations.
• Prepare documentation for peer‑to‑peer and physician‑advisor reviews.
• Maintain compliance with clinical and regulatory standards.

Required profile

• Active PHRN (Professional Hospital Registered Nurse) license.
• Minimum 2 years of critical‑care bedside experience in a tertiary hospital (ICU, CCU, Telemetry, ER, etc.).
• Experience must be within the past 5 years.
• Willingness to work onsite.

Required skills

What we offer

• Fixed weekends off.
• Pure non‑voice account.
• Market‑competitive pay.
• Retirement plan.
• Medical HMO plan from day 1.
• Dental, medical, and optical reimbursements.
• Life and disability insurance.
• Paid time‑off, sick‑leave conversion, and tuition‑fee reimbursement.
• Employee assistance program, performance‑based merit increases, and recognition programs.
• Training, staff development, referral and volunteer opportunities.