Inpatient Care Management Registered Nurse
2 weeks ago
About UnitedHealth Group: UnitedHealth Group is a worldwide organization dedicated to enhancing health through innovative technology, aiming to assist millions in achieving better health outcomes. Your contributions will directly influence the quality of care provided to individuals, ensuring they receive the necessary support and resources to thrive. Here, you will experience a culture that values diversity and inclusion, collaborates with skilled colleagues, and offers extensive benefits and opportunities for professional growth. Become a part of our mission to promote health equity on a global scale.
Position Overview: This role is designed for individuals who are passionate about improving healthcare delivery. You will be part of a dynamic team focused on providing superior care that surpasses traditional standards. Utilize your skills and expertise to influence the future of healthcare services.
Key Responsibilities:
- Conduct initial and ongoing assessments of inpatient cases using evidence-based criteria (MCG / InterQual criteria).
- Collaborate with healthcare professionals to develop comprehensive care plans.
- Work alongside Optum Enterprise Clinical Services Medical Directors to manage utilization effectively.
- Engage in discussions with the Clinical Services team to enhance care progression to suitable levels.
- Consult with the Medical Director for complex cases and refer to appropriate partners as necessary.
- Leverage clinical knowledge when communicating with internal and external Case Managers and Physicians.
- Identify and address delays in care or services in collaboration with medical professionals.
- Adhere to Standard Operating Procedures throughout the case management process.
- Gather clinical data to facilitate and expedite transitions to alternative care levels.
- Ensure timely and effective discharge planning and care delivery.
- Participate in team meetings, educational sessions, and relevant activities.
- Maintain compliance with federal, state, and accreditation standards.
- Identify and propose improvements in communication and processes.
- Engage in audit activities and related meetings.
What We Offer: You will be recognized for your contributions in an environment that encourages growth and provides clear guidance for success in your role. Opportunities for advancement into other positions will also be available.
Required Qualifications:
- A valid and unrestricted Compact RN license.
- A minimum of 3 years of clinical nursing experience in settings such as Acute Inpatient, SNF/AIR/LTAC, or Emergency Departments.
- At least 1 year of experience in utilization review and familiarity with evidence-based guidelines (MCG, InterQual).
- Proficiency in computer applications including Windows, IM, Excel (Microsoft Suite), Outlook, and clinical platforms.
- A designated workspace with secure high-speed internet access at home.
Preferred Qualifications:
- A Bachelor's degree in a relevant field.
- Certification in Case Management (CCM).
- Over 2 years of experience in case management or utilization review.
- Experience in Managed Care settings.
Additional Information: All remote employees must comply with UnitedHealth Group's Telecommuter Policy. UnitedHealth Group is committed to fostering a diverse workplace and is an Equal Employment Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates must pass a drug test prior to employment.
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