Utilization Management Nurse RN

UnitedHealth Group • Eugene, OR

297d • $59,500 - $116,600 • Onsite

About The Position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. 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 will have the flexibility to work remotely as you take on some tough challenges working in Arizona time zone schedule Mon-Fri 8-5 MST/PST.

Requirements

• Current, unrestricted RN license
• 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF / AIR / LTAC, Emergency Department, Urgent Care, Doctor's Office, School Nurse)
• Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
• Demonstrate a 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
• Oregon Resident

Nice To Haves

• Bachelor's degree
• Compact license
• 2+ years of case management experience
• 1+ years of experience that involves utilization review and evidence-based guidelines (InterQual Guidelines)
• Managed Care experience
• Experience performing discharge planning
• Demonstrated ability to work independently
• Demonstrated effective verbal and written communication skills

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
• Provide 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree