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 be Monday-Friday from 8AM-5PM EST with weekend rotations required
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. 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
You'll 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 residence
- 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF/AIR/ LTAC, Emergency Department, Urgent Care)
- Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
- Demonstrated 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
- Ability to work Monday-Friday 8am-5pm EST with required weekend rotations
Preferred Qualifications:- Bachelor's degree
- Compact RN License
- 2+ years of case management experience
- 1+ years of Background that involves utilization review and evidence-based guidelines (InterQual Guidelines)
- Managed care experience
- Experience performing discharge planning
*All employees working remotely will be required to adhere to UnitedHealth Group's 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, you'll 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.
