Inpatient Care Management Nurse RN - Remote
About The Position
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. 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. What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. You’ll enjoy the flexibility to work remotely as you take on some tough challenges. The candidate can live anywhere in the country but will need to follow the CST hours. This position will cover the Alabama market. For candidates located in the Eastern or Central Time Zone, this position offers remote work flexibility and the opportunity to tackle complex and rewarding challenges. Standard working hours are 8:00 a.m. to 5:00 p.m. based on your local time zone (EST or CST). Please note that the role includes regular weekend coverage rotations or a consistent schedule of Sunday through Thursday or Tuesday through Saturday.
Requirements
- Active, unrestricted RN license in state of residence
- 1+ years of clinical nursing experience in an Acute Inpatient Hospital setting
- 1+ years of experience in Utilization Review utilizing InterQual Guidelines, either within an Acute Inpatient Hospital setting or within a health insurance company
- 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
- Permanent residence in Eastern Standard Time or Central Standard Time
Nice To Haves
- Bachelor's degree
- Compact RN license
- 2+ years acute inpatient case management experience/utilization review
- Managed care experience
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
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
