Inpatient Care Management Registered Nurse
2 weeks ago
Join UnitedHealth Group, a leader in healthcare solutions, where we prioritize delivering exceptional medical services to all patients. Our team is dedicated to enhancing health outcomes and fostering a culture of compassion and collaboration.
As a Case Manager II - Inpatient Services RN, you will engage in both onsite and telephonic evaluations of inpatient admissions across various healthcare settings, including acute hospitals and rehabilitation facilities.
Your role will involve the implementation of care plans that adhere to established clinical guidelines, ensuring a seamless transition for members to appropriate lower levels of care. This collaboration will include working closely with hospital teams, physicians, and family members to coordinate care from admission through discharge.
Key Responsibilities:
- Collaborate independently with the Interdisciplinary Care Team (ICT) to develop personalized transition plans for members.
- Act as the clinical liaison with hospital staff, conducting reviews for clinical authorizations based on evidence-based criteria.
- Perform various types of clinical reviews, documenting medical necessity and appropriate care levels in accordance with recognized guidelines.
- Communicate effectively with facility staff and families to assess discharge needs and formulate comprehensive discharge plans.
- Utilize Population Stratification tools to identify member risk levels and communicate transition plans with the ICT.
- Conduct assessments to determine member needs during transitions to lower levels of care.
- Manage a designated caseload efficiently, employing strong time management skills.
- Demonstrate a thorough understanding of utilization management and care coordination processes to support transition planning.
Additionally, you will:
- Ensure timely and accurate documentation in care management applications to meet compliance and audit standards.
- Adhere to all organizational policies and procedures.
- Participate in on-call assignments as required.
- Maintain current licensure and hospital credentialing as necessary.
- Make informed decisions based on regulatory requirements and clinical guidelines.
- Stay updated on health plan benefits and provider networks.
- Refer complex cases to the appropriate medical directors for review.
Monitor quality concerns regarding member care and report them according to established policies.
This position offers a hybrid work environment, allowing for flexibility while maintaining a focus on patient care.
Required Qualifications:
- Bachelor's degree in Nursing or an Associate's degree in Nursing with a minimum of 4 years of relevant experience.
- Current, unrestricted RN license in the state of Texas.
- Case Management Certification (CCM) or the ability to obtain it within the first year of employment.
- At least 2 years of clinical experience with acutely ill patients.
- A minimum of 2 years of experience in managed care or case management.
- Proficiency in Microsoft Office applications.
- Reliable transportation for travel to client sites.
Preferred Qualifications:
- Experience with psychiatric and geriatric patient populations.
- Ability to analyze and interpret medical records and health plan documents.
- Strong problem-solving skills and knowledge of community resources.
- Excellent planning, organizing, and interpersonal skills.
- Capability to manage multiple tasks effectively.
- Utilize critical thinking and nursing judgment in decision-making.
At UnitedHealth Group, we are committed to improving health equity and addressing disparities in healthcare access. We believe in creating a diverse and inclusive environment where everyone can thrive.
Diversity and Inclusion: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer. We welcome applicants from all backgrounds and experiences.
We maintain a drug-free workplace and require candidates to pass a drug test prior to employment.
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