Hospital Safe Discharge RN Case Manager - Remote

UnitedHealth Group•Baltimore, MD

14h•$29 - $52•Remote

About The Position

The Hospital Safe Discharge RN Case Manager proactively contacts facility case management, utilization management, and discharge staff to coordinate member discharges. The role works with facility staff to identify and resolve discharge barriers and remains engaged through the actual discharge. It coordinates safe, efficient transitions of care with internal and external stakeholders, including hospitals, patients, families, and community services. The position is remote within the United States and follows an 8:00 a.m.–5:00 p.m. Eastern Time schedule, subject to change based on business needs. On-call assignments may be required.

Requirements

Bachelor of Science in Nursing.
Current, unrestricted RN license in a Compact State.
At least 5 years of nursing experience in an acute care setting.
At least 2 years of discharge-planning experience.
Knowledge of utilization management and quality improvement.
Computer proficiency with Microsoft Office applications, including Outlook, Word, and Excel.
Ability to read, analyze, and interpret information in medical records and health plan documents.
Ability to use critical thinking, nursing judgment, and decision-making skills.
Ability to prioritize, plan, and handle multiple tasks and demands simultaneously.
Ability to sit and stand for extended periods.
Ability to use fine motor skills to operate office equipment and/or machinery.
Ability to receive and comprehend instructions verbally and/or in writing.
Ability to use logical reasoning for simple and complex problem solving.
Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

Nice To Haves

Case Management certification.
At least 1 year of recent inpatient clinical documentation integrity (CDI) experience.
Experience with psychiatric and geriatric patient populations.
Experience with managed care and/or case management.
Experience managing patients with substance use disorder (SUD) and/or behavioral health conditions.
Knowledge of CMS coding guidelines and DRG assignment.
Experience with InterQual/MCG Guidelines or other nationally recognized practice guidelines.

Responsibilities

Assess barriers to safe and efficient discharge, identify relevant resources, and coordinate the discharge process with internal and external stakeholders.
Apply knowledge of acute inpatient case management, utilization management, and care coordination to transition planning.
Manage an assigned caseload efficiently using time-management skills.
Prepare and lead periodic rounds to review case needs, prioritize patients, discharges, issues, and facilities, and facilitate transitions of care.
Use electronic platforms, applications, and electronic medical record systems to coordinate care, document clinical information, and communicate with interdisciplinary teams.
Consult with the Medical Director or other leadership as appropriate regarding complex cases.
Apply working knowledge of skilled criteria for skilled nursing facilities, acute rehabilitation, and home health.
Identify and communicate members’ risk levels and participate in plans to mitigate risks.
Work with hospital staff, patients, families, and community services to promote safe discharge plans and quality care.
Support hospital staff in facilitating member transitions to other levels of post-acute care.
Build collaborative discharge-management relationships with hospitals and their personnel, including where relationships are new or challenging.
Identify opportunities to improve and streamline discharge processes and communicate ideas to leadership.
Collaborate with internal and external partners to drive safe discharges, increase daily discharge volume, and reduce length of stay.
Use available tools and communication platforms to support members’ post-discharge transitions of care.
Enter timely and accurate documentation in designated care management applications, meeting documentation requirements and monthly audit scores of 90% or better.
Follow organizational and departmental policies and procedures.
Take on-call assignments as directed.
Make decisions based on regulatory requirements, policies and procedures, and current clinical guidelines.
Maintain current knowledge of health plan benefits and provider networks, including contract inclusions and exclusions.
Refer cases for additional support or management as appropriate and in accordance with mandated reporting laws and ethical requirements.
Monitor for quality concerns regarding member care and report them according to policy and procedure.
Perform other related duties as assigned.