As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization.
Schedule will vary to include some weekend requirements based off the business needs.
If you are located in Missouri, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:- Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria)
- Discuss cases with facility healthcare professionals to obtain plans-of-care
- Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management
- Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
- Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners
- Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
- Identify delays in care or services and manage with MD
- Follow all Standard Operating Procedures in end-to-end management of cases
- Obtain clinical information to assess and expedite alternate levels of care
- Facilitate timely and appropriate care and effective discharge planning
- Participate in team meetings, education, discussions, and related activities
- Maintain compliance with Federal, State and accreditation organizations
- Identify opportunities for improved communication or processes
- Participate in audit activities and meetings
You9ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- Active, unrestricted RN license in state of MO
- 3+ years of clinical nursing experience in a Hospital setting
- Proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms
- Designated workspace and access to install secure high-speed internet via cable / DSL in home
- Reside in MO
Preferred Qualifications:- Bachelor9s degree
- Compact RN license
- 2+ years of acute inpatient case management experience/utilization review
- 1+ years of experience in Utilization Review, either within an Acute Inpatient Hospital setting or within a health insurance company
- Managed care experience
- Experience performing discharge planning
*All employees working remotely will be required to adhere to UnitedHealth Group9s Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you9ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
