[Hiring] Inpatient Care Management Nurse @UnitedHealth Group

Role Description

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.

You’ll enjoy the flexibility to work remotely from the Pacific, Mountain, or Central Time Zone regions within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (i.e. MCG/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
• Participate 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 cases 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

Qualifications

• Current, unrestricted RN license in state of Residence
• 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
• 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

Requirements

• Bachelor’s degree (Preferred)
• Compact license (Preferred)
• 1+ years of experience involving utilization review and evidence-based guidelines (i.e. MCG, InterQual Guidelines) (Preferred)
• Managed Care experience (Preferred)
• Experience performing discharge planning (Preferred)
• Demonstrated ability to work independently (Preferred)
• Demonstrated effective verbal and written communication skills (Preferred)

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Company Description

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.