Clinical Analyst (RN) – Remote (USA)
Organization: Optum (UnitedHealth Group)
Category: Medical & Clinical Operations / Stop Loss, Large-Claim Risk, Cost Containment
Location: Eden Prairie, MN (work remote anywhere in the U.S.)
Work Mode: Remote
Compensation: $71,200 – $127,200 per year (based on experience & eligibility factors)
Schedule: Monday–Friday (standard business hours)
Job Summary
Optum is seeking a Clinical Analyst (RN)—also functioning as a Stop Loss Nurse Consultant—to review large-dollar medical claims, project medical costs, identify risk, and implement cost-containment strategies. This full-time remote position is ideal for experienced critical care/ER/ICU nurses who want to transition from bedside to a data-driven, claims-focused clinical operations role using authoritative sources such as NCCN, CDC, Predict Dx.
Key Responsibilities
Review & assess Large Claim Notices (LCNs) within 48 business hours; set up high-cost claimants in POWER for continuous risk assessment.
Estimate cost of care (new & renewal business) within defined SLAs (24–48 business hours).
Track claimants bi-weekly/monthly; notify underwriters & claims auditors as risk evolves.
Research clinical trends, treatments & outcomes using reputable clinical resources (NCCN, CDC, etc.).
Identify cost-containment opportunities and collaborate with TPAs, case managers, underwriters & vendors.
Co-manage complex cases (e.g., dialysis, transplants) with specialty coordinators.
Provide clinical file reviews, experimental/investigational reviews, and support reserve allocation.
Produce Hot Claims reports; attend monthly Account Management/Sales calls.
Maintain complete documentation, indexing & timely diary follow-ups in POWER.
Required Skills & Qualifications
Active, unrestricted RN license (state of residence).
5+ years of clinical experience.
2+ years in ER/ICU/Critical Care.
2+ years in insurance/managed care/TPA environments.
1+ year of hands-on Excel experience (formulas, filtering, sorting, analysis).
Strong knowledge of utilization management, risk assessment, and large-claim review.
Excellent organization, multitasking, and documentation skills.
Preferred Qualifications
Employer or Provider Stop Loss / HMO experience.
Demonstrated strength in medical cost projection & reserve setting.
Solid Internet research skills; proficiency in Microsoft Word & Excel.
Perks & Benefits
Salary: $71,200 – $127,200 (annual, full-time).
Comprehensive health, dental, vision plans.
401(k) with company contribution & equity stock purchase plan.
Incentive & recognition programs.
Career mobility across UnitedHealth Group’s global network.
Company Description
Optum, part of UnitedHealth Group, combines clinical expertise, data, and technology to improve health outcomes, reduce costs, and elevate patient and payer value. Within OptumHealth, you’ll join a mission-driven team transforming care delivery and modernizing large-claim analysis and stop-loss risk management.
Work Mode: Remote (United States)
Apply Now
Ready to move from bedside to a high-impact, analytics-driven clinical role? Apply now and help Optum deliver smarter, safer, and more affordable care.
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