Inpatient Care Management Nurse RN - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.

About the role

As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will assess and interpret member needs and identify solutions that will help our members live healthier lives. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Responsibilities

• Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria)
• Discuss cases with facility healthcare professionals to obtain plans-of-care
• Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management
• Participate in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
• Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners
• Apply clinical expertise when discussing cases with internal and external Case Managers and Physicians
• Identify delays in care or services and manage with MD
• Follow all Standard Operating Procedures in end-to-end management of cases
• Obtain clinical information to assess and expedite alternate levels of care
• Facilitate timely and appropriate care and effective discharge planning
• Participate in team meetings, education, discussions, and related activities
• Maintain compliance with Federal, State and accreditation organizations
• Identify opportunities for improved communication or processes
• Participate in audit activities and meetings

Requirements

• Active, unrestricted RN license in state of residence
• 3+ years of clinical nursing experience in a Hospital setting
• Proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms
• Designated workspace and access to install secure high-speed internet via cable / DSL in home
• Ability to work one weekend (Sat and Sun) approximately every six weeks

Preferred Qualifications

• Bachelor's degree
• Compact RN license
• 2+ years of acute inpatient case management experience/utilization review
• 1+ years of experience in Utilization Review, either within an Acute Inpatient Hospital setting or within a health insurance company
• Managed care experience
• Experience performing discharge planning

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Pay

The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.

Schedule

Schedule will vary to include some weekend requirements based on business needs. All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.