Inpatient Care Management Nurse - Remote

As an Inpatient 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 identifying solutions that will help our members live healthier lives.

Schedule will vary to include some weekend requirements based off the business needs.

If you are located in Missouri, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary 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
• Participation 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 case 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

Required Qualifications

• Active, unrestricted RN license in state of MO
• 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
• Reside in MO

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

*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.