Inpatient Case Management Registered Nurse

1 week ago

Corpus Christi, Texas, United States UnitedHealth Group Full time

Opportunities at UnitedHealth Group - a leader in the healthcare industry dedicated to providing exceptional medical services. We are committed to ensuring that all patients receive the highest standard of care. Here, you will become part of a dedicated team focused on improving health outcomes and enhancing patient experiences.

The Inpatient Case Manager RN is responsible for conducting both onsite and telephonic evaluations of inpatient admissions in various healthcare settings, including acute hospitals and rehabilitation facilities. This role involves implementing care plans based on established clinical guidelines to facilitate smooth transitions for patients to appropriate lower levels of care, in collaboration with healthcare teams, facility staff, and patients or their families.

Key Responsibilities:

  • Collaborate independently with interdisciplinary teams to develop personalized transition plans for patients.
  • Act as the clinical liaison with hospital staff and perform clinical authorization reviews for inpatient care using evidence-based criteria.
  • Conduct various types of clinical reviews, documenting medical necessity and appropriate care levels according to nationally recognized guidelines.
  • Communicate effectively with facility staff, patients, and their 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 interdisciplinary team.
  • Perform transition assessments to determine patient needs during the shift to lower levels of care.
  • Manage a caseload efficiently, demonstrating strong time management skills.
  • Maintain accurate documentation in care management systems to meet compliance and quality standards.
  • Adhere to all organizational policies and procedures.
  • Participate in on-call assignments as required.
  • Ensure current licensure and hospital credentialing are maintained.
  • 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.

This position offers a hybrid work environment, providing 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 in managing acutely ill patients.
  • Minimum of 2 years of experience in managed care or case management.
  • Proficiency in Microsoft Office applications.
  • Reliable transportation for travel to patient 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 prioritize and manage multiple tasks effectively.
  • Utilize critical thinking and nursing judgment in decision-making.

At UnitedHealth Group, we strive to create a healthier world by addressing health disparities and improving health outcomes for all individuals. We are committed to fostering an inclusive environment where diversity is valued and every individual has the opportunity to thrive.

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

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