RN Concurrent Review - UM - Remote - Kelsey Seybold Clinic

UnitedHealth Group•Pearland, TX

1d•$60,200 - $107,400•Remote

About The Position

The Concurrent Review Case Manager is responsible for telephonic monitoring and the documentation of medical treatment and comparing it to established criteria to determine if treatment meets established guidelines. In addition, the Concurrent Review Case Manager monitors patients progress toward recovery for early identification of continuing care needs in an attempt to facilitate discharge for specified populations. This position works closely with Medical Management Physician leadership and various internal departments. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Requirements

Registered Nurse, ADN or master’s degree in Social Work
TX RN license or TX LCSW license, valid Texas Driver’s license
5+ years of nursing experience or 3+ years of experience in medical social work with an emphasis in case management of high risk patient population
Managed Care knowledge
Proven communication and problem-solving skills; Computer literate

Nice To Haves

Certification in area of specialization, BSN ACP certification
Case Management Certification
Proven program development skills
2+ years in area of specialization, 2+ years of Case Management/Utilization Review experience

Responsibilities

Performs concurrent and retrospective reviews for selected inpatient populations
Evaluates the need for discharge planning and assists the external case managers with discharge planning needs and authorizations under the supervision of the hospital-based physicians and Medical Director of Managed Care
Completes documentation timely and accurately as it pertains to all clinical information obtained during the patient’s hospitalization
Collaborates with outside case managers, clinic staff, and providers to coordinate patient care
Serves as a resource to physicians, clinic staff, and patients regarding the concurrent or retrospective review process
Attends relevant clinic meetings and provides feedback for process improvement
Other duties as assigned