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Registered Nurse
2 months ago
About UnitedHealth Group: UnitedHealth Group is a worldwide organization dedicated to enhancing health outcomes through innovative technology and compassionate care. Our mission is to support individuals in leading healthier lives, and your contributions will play a vital role in achieving this goal. We pride ourselves on fostering a culture of diversity and inclusion, providing talented colleagues, comprehensive benefits, and ample opportunities for career advancement.
Position Overview: This role is fully remote and available to candidates nationwide. You will be expected to work Monday through Friday from 8 AM to 5 PM CST.
Key Responsibilities:
- Conduct initial and ongoing assessments of inpatient cases using evidence-based criteria (MCG / InterQual criteria).
- Collaborate with healthcare professionals in facilities to develop comprehensive care plans.
- Work alongside Medical Directors within Optum Enterprise Clinical Services 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 facilitate referrals to appropriate partners.
- Utilize clinical expertise when interacting with internal and external Case Managers and Physicians.
- Identify and address delays in care or services in collaboration with the Medical Director.
- Adhere to Standard Operating Procedures for the complete management of cases.
- Gather clinical information to assess and expedite transitions to alternate levels of care.
- Ensure timely and effective discharge planning and care facilitation.
- Participate in team meetings, educational sessions, and relevant discussions.
- Maintain compliance with Federal, State, and accreditation standards.
- Identify opportunities for enhancing communication and processes.
- Engage in audit activities and meetings as required.
What We Offer: At UnitedHealth Group, your performance will be recognized and rewarded in an environment that challenges you while providing clear guidance for success. We are committed to your professional development and offer pathways to explore other roles within the organization.
Required Qualifications:
- Current and unrestricted Compact RN license.
- Minimum of 3 years of clinical nursing experience in acute inpatient settings, SNF/AIR/LTAC, or Emergency Departments.
- At least 1 year of experience in utilization review and familiarity with evidence-based guidelines (MCG, InterQual).
- Proficient in computer skills, including Windows, IM, Excel (Microsoft Suite), Outlook, and clinical platforms.
- A designated workspace with access to secure high-speed internet via cable/DSL.
Preferred Qualifications:
- Bachelor's degree in nursing.
- Certification in Case Management (CCM).
- Over 2 years of experience in case management or utilization review.
- Experience in Managed Care settings.
Additional Information: UnitedHealth Group is committed to creating a diverse and inclusive workplace. We are an Equal Employment Opportunity/Affirmative Action employer, and 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 are required to pass a drug test before beginning employment.