Concurrent Review RN - Utilization Management - Remote

The Concurrent Review Case Manager is responsible for telephonic monitoring and the documentation of medical treatment and comparing it to established criteria to determine if treatment meets established guidelines. In addition, the Concurrent Review Case Manager monitors patients progress toward recovery for early identification of continuing care needs in an attempt to facilitate discharge for specified populations. This position works closely with Medical Management Physician leadership and various internal departments.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Performs concurrent and retrospective reviews for selected inpatient populations
• Evaluates the need for discharge planning and assists the external case managers with discharge planning needs and authorizations under the supervision of the hospital-based physicians and Medical Director of Managed Care
• Completes documentation timely and accurately as it pertains to all clinical information obtained during the patient's hospitalization
• Collaborates with outside case managers, clinic staff, and providers to coordinate patient care
• Serves as a resource to physicians, clinic staff, and patients regarding the concurrent or retrospective review process
• Attends relevant clinic meetings and provides feedback for process improvement
• Other duties as assigned

Required Qualifications

• Registered Nurse, ADN or master's degree in Social Work
• TX RN license or TX LCSW license, valid Texas Driver's license
• 5+ years of nursing experience or three years' experience in medical social work with an emphasis in case management of high risk patient population
• Managed Care knowledge
• Proven communication and problem-solving skills; Computer literate

Preferred Qualifications

• Certification in area of specialization, BSN
• ACP certification
• Case Management Certification
• 2+ years in area of specialization, 2+ years of Case Management/Utilization Review experience
• Proven program development skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary for this role will range from $60,200 - $107,400 annually based on full-time employment.