11 days old

Inpatient Care Management Nurse RN PST Time Zone Telecommute - 920633

Sacramento, CA 95814 Work Remotely
  • Job Code
    920633

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

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As anInpatient Care Management Nurse,you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifyingsolutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization.

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What makes your nursing career greater with Optum? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

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Work schedule will be business hours Monday to Friday in the Pacific Time Zone.

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If you are located in Pacific Time Zone, you will have the flexibility to telecommute* as you take on some tough challenges.

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Primary Responsibilities:

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  • Perform initial and concurrent review of inpatient cases applying MCG criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination
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  • Discuss cases with facility healthcare professionals to obtain plans-of-care
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  • Collaborate with UnitedHealthcare Medical Directors on performing utilization management
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  • Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
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  • Consult with the Medical Director as needed for complex cases and make appropriate referrals to sister segments
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  • Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
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  • Identify delays in care or services and manage with MD
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  • Follow all Standard Operating Procedures in end to end management of cases
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  • Obtain clinical information to assess and expedite alternate levels of care
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  • Facilitate timely and appropriate care and effective discharge planning
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  • Participate in team meetings, education discussions and related activities
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  • Maintain compliance with Federal, State and accreditation organizations
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  • Identify opportunities for improved communication or processes
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  • Participate in telephonic and in-person staff meetings
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  • Build and maintain relationships
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  • Gather clinical information to assess and expedite care needs
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  • Maintain appropriate and accurate documentation
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Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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Required Qualifications:

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  • A current, unrestricted California RN license
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  • 3+ years of total RN experience including clinical experience in an inpatient / acute setting
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  • 1+ yearsof UM / UR experience required including experience performing admission and continued inpatient stay reviews using evidenced based criteria
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  • Demonstrated proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms
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  • Designated workspace and access to install secure high-speed internet via cable / DSL in home
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  • Able to work 8AM to 5 PM PST Monday to Friday
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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  • Bachelors degree
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  • Experience in discharge planning and/or chart review
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  • Compact license
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  • Experience with utilization review for an insurance company or in a managed care environment
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  • Familiarity with InterQual guidelines
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Diversity creates a healthier atmosphere: UnitedHealth Group is 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.

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

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Job Keywords: Utilization Review; Utilization Management; concurrent Review; Interqual; UM; UR; RN; Registered Nurse; Inpatient; Discharge Planning, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

Categories

Posted: 2021-04-05 Expires: 2021-05-05

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Inpatient Care Management Nurse RN PST Time Zone Telecommute - 920633

UnitedHealth Group
Sacramento, CA 95814

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