Utilization Management Nurse - 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. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Requirements
- A current, unrestricted RN license in resident state
- 3+ years of total experience including recent clinical experience in an inpatient/acute setting
- Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
- Experience performing discharge planning
- Experience in Utilization review and/or Utilization management
- Prove solid computer skills
Nice To Haves
- Bachelor’s degree
- Certification in Case Management or willingness to obtain
- 2+ years of case management
- Experience with MCG Guidelines or InterQual
- Proven ability to work independently
- Demonstrates effective verbal and written communication skills
Responsibilities
- Perform initial and concurrent review of inpatient cases applying criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination
- Discuss cases with facility healthcare professionals to obtain plans-of-care
- Collaborate with UnitedHealthcare Medical Directors on performing utilization management
- Participation in 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 sister segments
- 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 telephonic staff meetings
- Plan for MCG Certification
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
