There's energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As an Inpatient Care Manager 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 identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready for a new path? Join us and start doing your life's best work.(sm)What makes your nursing career greater with UnitedHealth Group? 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. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:Perform utilization and concurrent review of inpatient cases using MCG criteria Conduct clinical chart assessments Build and maintain relationships Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care Participate in rounds with the Medical Director and discussing cases as needed Determine need, if any, for intervention and discussing with Case Managers and physicians Identify and evaluate delays in care Initiate a discharge planning and readmission prevention plan Approve bed days for inpatient cases (when applicable) Arrange alternative care services; contact and maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum Gather clinical information to assess and expedite care needs Facilitate timely and appropriate care and effective discharge planning Participate in team meetings, education discussions, and related activities Maintain appropriate documentation using the clinical platform Consult with the Medical Director as needed to troubleshoot difficult or complex cases Identify opportunities for improved communication or processes Participate in telephonic and in-person staff meetings
Required Qualifications:A current, unrestricted RN license 3+ years total RN experience including recent hands on clinical experience in an inpatient acute setting in ICU / CCU / ER / Medical-Surgical Must demonstrate a proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms Must have a work space in their home that is separated from non-workspace areas and that can be secured to maintain Protected Health Information (PHI) and / or Protected Information (PI) Must be living in a location that can receive high-speed internet service with a minimum speed of 1.5 download mps & 1 upload mps. Mobile cellular data, e.g., fixed wireless, air cards / MiFi devices, and satellite are not approved means of internet connectivity and do not meet the criteria for high-speed internet connection through an Internet Service ProviderPreferred Qualifications:1+ years of Utilization Review experience in Managed Care or in an Acute Hospital setting Experience in the use of MCG or Interqual criteria 2+ years of case management experience MCG or Case management certification Experience in discharge planning and / or clinical chart review Experience in acute long term care, acute rehabilitation, or skilled nursing facilities Managerial experience Bachelor's degree Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work. (sm) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Diversity creates a healthier atmosphere: 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. Job Keywords: Registered Nurse, RN, RN Case Manager, Utilization Manager, Utilization Review RN, Concurrent Review RN, Telecommute, Telecommuting, Work From Home, UM Nurse, CCR RN, Managed Care, case management, Telecommute, UHC, Unitedhealthcare
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.