Travel Nurse

5 days ago

Nashville, Tennessee, United States UnitedHealth Group Full time
Job Summary

UnitedHealth Group is seeking a highly skilled Travel Nurse to join our team as a Case Manager/Utilization Review. This is a 100% travel position that requires the ability to work remotely from anywhere within the U.S. and take on some tough challenges.

Key Responsibilities
  • Provide comprehensive care management or utilization review services in various locations.
  • Coordinate patient services through an interdisciplinary process, which provides a clinical and psychosocial approach through the continuum of care.
  • Assess patients to determine appropriateness of admission, continued hospitalization, and appropriate level of care.
  • Facilitate timely care delivery at the right time and in the right setting, escalate operational barriers, and collaborate with all stakeholders.
  • Discharge planning will begin at the time of (or prior to) admission and will be reassessed ongoing throughout the course of hospitalization in partnership with the clinical care team, the patient, and/or the patient's representative.
  • Continuum of Care Planning
  • Responsible for integrating the assessment of the need for post-hospital services and determination of an appropriate discharge plan for complex cases.
  • Educates patient/family as to options/choices within the level of care determined to be appropriate.
  • Initiates and insures completion of all necessary paperwork.
  • Facilitates completion of orders as required prior to transfer of patient to the next level of care in a timely manner so discharge is not delayed.
  • Utilization Review Nurse
  • Provides utilization management services, in coordination with other Case Management staff, providers, and other healthcare team members, using pre-established guidelines and criteria to perform review activities to assure the proper utilization of hospital services and payment of those services by Medicare, Medicaid, and other third-party payors.
  • Proactively provide necessary medical information to justify the medical necessity of the hospital stay and will take necessary follow-up action to assist in the appeal processes of denials.
  • Has knowledge of all applicable federal and state regulations.
  • Demonstrates a working knowledge of managed care and Medicare health plans as well as reimbursement related to post-acute services within the continuum of care.
  • Consults with physician section leaders for support in cases that continued stay is not appropriate and case manager is unable to come to resolution by working with assigned physician.
  • Communicating with the department director length of stay (LOS) and financial information, as well as issues that may affect the continuum of care process.
  • Engages attending physicians or ED physicians as appropriate if clinical information is incomplete or needs clarification.
  • Consultative Services:
  • Provide consulting services in care management redesign with the frontline team members.
  • Supports front line redesign for care management transformation in conjunction with operations and transformational leaders and team.
  • Synthesizes findings and summarizes a broad range of data inputs into outputs that clearly communicate data findings and insights.
Requirements
  • 2+ years of experience in an Acute Care Hospital performing discharge planning as a Case Manager.
  • 2+ years of Utilization Management experience in a hospital or with a Third-Party Payor.
  • Experience with Inpatient care, in Acute Care Hospital.
  • Knowledge of Utilization Review, Medicare Requirements processes, as well as State and Federal regulations pertaining to Utilization Review and Discharge Planning.
  • Knowledge/understanding of InterQual and/or MCG criteria of medical necessity.
  • Proven ability to compile, evaluate, and report statistics to members of the team as well as to utilize this information to facilitate process improvement activities.
  • Proven ability to compile, evaluate, and present clinical information to justify hospitalization to outside Third-Party Payors.
  • Ability to travel 100%.
Preferred Qualifications
  • Case Management Certification.
  • Basic Life Support certification.
  • Certification in CCM (certified case manager), ACM (Accredited Case Manager), MCG, and/or InterQual.
  • Traveler experience.
  • MSN.
  • Clinical knowledge of the Labor and Delivery, Neonatal, Medical Surgical, Oncology, ICU patient and process.

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