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Inpatient Case Management Registered Nurse
2 months ago
About UnitedHealth Group
At UnitedHealth Group, we are dedicated to providing exceptional healthcare services. Our mission is to ensure that every patient receives the highest standard of medical attention. As part of our team, you will contribute to a culture of **Caring. Connecting. Growing together.**
Position Overview:
The Inpatient Case Manager RN is responsible for conducting both onsite and telephonic evaluations of inpatient admissions across various healthcare settings, including acute hospitals and rehabilitation facilities. This role is pivotal in implementing care plans that align with established clinical guidelines, ensuring a smooth transition for patients to lower levels of care. Collaboration with hospital teams, physicians, and family members is essential to coordinate care from admission through discharge.
Key Responsibilities:
- Collaborate independently with the Interdisciplinary Care Team (ICT) to develop tailored transition plans for patients.
- Act as the clinical liaison with hospital staff, performing clinical reviews for inpatient care based on evidence-based criteria.
- Conduct various types of clinical reviews, documenting medical necessity and appropriate care levels in accordance with national guidelines.
- Communicate effectively with facility staff and families to assess discharge needs and create comprehensive discharge plans.
- Utilize Population Stratification tools to identify patient risk levels and communicate transition plans with the ICT.
- Perform assessments to determine patient needs during transitions to lower levels of care.
- Manage a designated caseload efficiently, employing strong time management skills.
- Maintain 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 needed.
- Ensure current licensure and hospital credentialing as required.
- Make informed decisions based on regulatory standards and clinical guidelines.
- Stay updated on health plan benefits and provider networks.
- Report any quality concerns regarding patient care as per established protocols.
Qualifications:
- Bachelor's degree in Nursing or an Associate's degree in Nursing with 4+ years of relevant experience.
- Valid RN license in the state of employment.
- Case Management Certification (CCM) or the ability to obtain it within the first year of employment.
- Minimum of 2 years of clinical experience with acutely ill patients.
- Experience in managed care or case management for at least 2 years.
- Proficiency in Microsoft Office applications.
- Reliable transportation for travel to various healthcare facilities.
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 prioritize and manage multiple tasks effectively.
- Utilize critical thinking and nursing judgment in decision-making.
UnitedHealth Group is committed to fostering a diverse and inclusive workplace. We believe that diversity enhances our ability to provide equitable care and improve health outcomes for all individuals.
