Out of Area RN Case Manager

UnitedHealth Group•Orlando, FL

11d•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. As the RN Case Manager you are responsible for the Utilization Management and coordination of Case Management services for members hospitalized in acute/subacute settings outside the service area. Case managers works directly with the member, providers(s), facilities and other entities to ensure the most appropriate care is provided. The Case Manager manages members from various product lines. The Case Manager assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the member's health needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost - benefit interventions and outcomes.

Requirements

Current, unrestricted license RN license in the state of Nevada
2+ years of acute clinical experience
Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word and Excel
Ability to obtain additional license as required
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Candidates are required to pass a drug test before beginning employment.

Nice To Haves

Bachelor's degree in Nursing
Case management in a managed care environment
Knowledge and/or experience with InterQual
Previous med-surg, telemetry, pediatric and/or critical care experience
Utilization review experience in an acute/sub-acute setting
Proven knowledge of CMS and other regulatory agencies
Excellent inbound and outbound telephonic skills

Responsibilities

Making outbound calls to assess members' current health status
Utilizing InterQual criteria to determine if patients are in the correct hospital setting
Coordination of member's care through the health care continuum
Collaborate with the member, provider, & the facility to obtain the best outcome
Collaborate with members of the health care team, to include attending physicians, hospital Utilization Management teams, Home Health agencies, Sub-acute care teams, Durable Medical Equipment teams, PCP’s, internal UM and CM teams and the health plan Medical Director.
Complete cost - benefit analysis as appropriate
Identifying gaps or barriers in treatment plans
Review cases with Medical Directors daily on challenging cases and as needed
Making referrals to outside sources
Documenting and tracking findings