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Registered Nurse RN Inpatient Case Manager Healthcare Professional

2 months ago

Houston, Texas, United States UnitedHealth Group Inc Full time
About the Role

We are seeking a highly skilled and experienced Registered Nurse RN Inpatient Case Manager to join our team at UnitedHealth Group Inc. As a key member of our healthcare team, you will play a critical role in ensuring the seamless transition of patients from acute care settings to lower levels of care.

Key Responsibilities
  • Collaborate effectively with interdisciplinary care teams to establish individualized transition plans for patients
  • Serve as the clinical liaison with hospital, clinical, and administrative staff, and perform reviews for clinical authorizations for inpatient care utilizing evidence-based criteria
  • Conduct expedited, standard, concurrent, and retrospective onsite or telephonic clinical reviews at in-network and/or out-of-network facilities
  • Interact and communicate effectively with facility staff, patients, and their families/designated representatives to assess discharge needs, formulate discharge plans, and provide health plan benefit information
  • Identify patients' levels of risk by utilizing population stratification tools and communicate during the transition process the patients' transition discharge plans with the ICT
  • Conduct transition discharge assessments onsite and/or telephonically to identify patients' needs at the time of transition to a lower level of care
  • Manage assigned case loads in an efficient and effective manner utilizing time management skills
  • Demonstrate exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities
  • Independently confer with UM Medical Directors and/or Market Medical Directors on a regular basis regarding inpatient cases and participate in department huddles
  • Enter timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better on a monthly basis
  • Adhere to organizational and departmental policies and procedures
  • Take on-call assignments as directed
  • Maintain current licensure to work in the state of employment and maintain hospital credentialing as indicated
Requirements
  • Bachelor's degree in Nursing and/or Associate's degree in Nursing combined with 4 or more years of experience above the required years of experience
  • Current, unrestricted RN license required, specific to the state of employment
  • Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
  • 4+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions
  • 3+ years of managed care and/or case management experience
  • Knowledge of utilization management, quality improvement, and discharge planning
  • Ability to read, analyze, and interpret information in medical records and health plan documents
  • Ability to problem-solve and identify community resources
  • Possess planning, organizing, conflict resolution, negotiating, and interpersonal skills
  • Knowledgeable in Microsoft Office applications, including Outlook, Word, and Excel
  • Utilize critical thinking skills, nursing judgment, and decision-making skills
  • Ability to prioritize, plan, and handle multiple tasks/demands simultaneously
Preferred Qualifications
  • Experience working with psychiatric and geriatric patient populations
  • Bilingual (English/Spanish) language proficiency
Physical and Mental Requirements
  • Ability to lift up to 25 pounds
  • Ability to push or pull heavy objects using up to 10 pounds of force
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem-solving