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Inpatient Case Manager RN Healthcare Specialist
2 months ago
We are seeking a highly skilled Registered Nurse to join our team as an Inpatient Case Manager. As a key member of our healthcare team, you will be responsible for coordinating the care of patients in acute hospitals, rehabilitation facilities, and skilled nursing facilities.
Key Responsibilities- Collaborate with interdisciplinary care teams to establish individualized transition plans for patients
- Review clinical authorizations for inpatient care using evidence-based criteria
- Perform expedited, standard, concurrent, and retrospective clinical reviews at in-network and out-of-network facilities
- Communicate with facility staff, patients, and their families to assess discharge needs and provide health plan benefit information
- Identify patient risk levels using population stratification tools and communicate transition plans with care teams
- Conduct transition discharge assessments to identify patient needs at time of transition to a lower level of care
- Manage assigned case load efficiently and effectively using time management skills
- Bachelor's degree in Nursing and/or Associate's degree in Nursing combined with 4+ years of experience
- Current, unrestricted RN license required in the state of TX
- Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
- 2+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions
- 2+ years of managed care and/or case management experience
- Proven knowledge in Microsoft Office applications including Outlook, Word, and Excel
- Experience working with psychiatric and geriatric patient populations
- 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
- Ability to prioritize, plan, and handle multiple tasks/demands simultaneously
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.
